{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:16:55Z","timestamp":1790921815924,"version":"4.1.0"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background:Streptococcus pneumoniae is a well-known pathogen responsible for respiratory and invasive diseases; however, central nervous system (CNS) involvement in the form of bacterial myelitis is exceedingly rare, particularly in immunocompetent adults. Moreover, the association between pneumococcal infections and reactive arthritis is scarcely documented. We report an unusual case of pneumococcal myelitis complicated by reactive arthritis in an elderly patient with no evident immunosuppression. Case Presentation: A 68-year-old man with a medical history of hypertension, benign prostatic hyperplasia, multiple disc herniations, and a resected pancreatic neuroendocrine tumour presented to the emergency department with acute urinary retention and fever (38.5 \u00b0C). The neurological examination revealed lower limb weakness and decreased deep tendon reflexes. Spinal magnetic resonance demonstrated T2 hyperintense lesions suggestive of longitudinally transverse myelitis. Cerebrospinal fluid (CSF) analysis showed pleocytosis with elevated protein levels; the polymerase chain reaction (PCR) test resulted positive result for Streptococcus pneumoniae. The patient received intravenous antimicrobial and corticosteroid therapy with partial neurological improvement. Within days, he developed acute monoarthritis of the right ankle. Joint aspiration revealed sterile inflammatory fluid, negative for crystals and cultures, supporting a diagnosis of reactive arthritis. The articular symptoms resolved with the use of prednisone. An extensive immunological work-up was negative, and no other infectious or autoimmune triggers were identified. The patient underwent a structured rehabilitation program with gradual improvement in motor function over the following weeks. Conclusions: This case illustrates a rare clinical scenario of pneumococcal myelitis associated with reactive arthritis in a patient without overt immunosuppression. It highlights the importance of considering bacterial aetiologies in cases of acute transverse myelitis and the potential for unusual systemic immune responses such as reactive arthritis. Early recognition and the administration of appropriate antimicrobial and supportive therapies are crucial for improving neurological and systemic outcomes. To our knowledge, this is one of the first reported cases describing the co-occurrence of these two conditions in the context of S. pneumoniae infection.<\/jats:p>","DOI":"10.3390\/idr17060147","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:35:51Z","timestamp":1765190151000},"page":"147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When Fever Strikes Twice: A Case Report of Streptococcus pneumoniae Myelitis with Delayed-Onset Reactive Arthritis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1297-5860","authenticated-orcid":false,"given":"Rosario Luca","family":"Norrito","sequence":"first","affiliation":[{"name":"Internal Medicine Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Mastrilli","sequence":"additional","affiliation":[{"name":"Neurology Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Fiorello","sequence":"additional","affiliation":[{"name":"Internal Medicine Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Taormina","sequence":"additional","affiliation":[{"name":"Internal Medicine Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Di Giorgi","sequence":"additional","affiliation":[{"name":"Neurology Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia Mery Anna","family":"Ruggirello","sequence":"additional","affiliation":[{"name":"Neurology Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4868-9033","authenticated-orcid":false,"given":"Carlo Domenico","family":"Maida","sequence":"additional","affiliation":[{"name":"Internal Medicine Ward, Sant\u2019Elia Hospital, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Piazza","sequence":"additional","affiliation":[{"name":"Neurology Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Cartabellotta","sequence":"additional","affiliation":[{"name":"Internal Medicine Ward, Buccheri La Ferla Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(12)61186-6","article-title":"Advances in treatment of bacterial meningitis","volume":"380","author":"Brouwer","year":"2012","journal-title":"Lancet"},{"key":"ref_2","first-page":"395","article-title":"Pneumococcal spinal infections: Rare presentations and diagnostic pitfalls","volume":"6","author":"Muthukumar","year":"2015","journal-title":"J. Neurosci. Rural Pract."},{"key":"ref_3","first-page":"167","article-title":"Transverse myelitis\u2014A review of the presentation, diagnosis, and initial management","volume":"16","author":"West","year":"2013","journal-title":"Discov. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e249514","DOI":"10.1136\/bcr-2022-249514","article-title":"Purpura fulminans due to Streptococcus pneumoniae bacteraemia in an unsplectomised immunocompetent adult without primary hypocomplementaemia","volume":"15","author":"Sathyanarayanan","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5435\/JAAOS-D-13-00102","article-title":"Bacterial Spine Infections in Adults: Evaluation and Management","volume":"24","author":"Cornett","year":"2016","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e923266","DOI":"10.12659\/AJCR.923266","article-title":"Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review","volume":"21","author":"Djurdjevic","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.11604\/pamj.2024.49.11.43180","article-title":"Longitudinally transverse myelitis as a rare complication of pneumococcal meningitis: case report","volume":"49","author":"Sakly","year":"2024","journal-title":"Pan Afr. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.33588\/rn.7501.2021215","article-title":"Cranial multineuritis and transverse myelitis as complications of pneumococcal meningitis","volume":"75","author":"Roche","year":"2022","journal-title":"Rev. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1086\/649540","article-title":"Reactive arthritis after enteric infections in the United States: The problem of definition","volume":"50","author":"Townes","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.berh.2011.01.018","article-title":"Reactive arthritis","volume":"25","author":"Hannu","year":"2011","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1752-1947-1-2","article-title":"Reactive arthritis developing after pneumococcal conjunctivitis: A case report","volume":"1","author":"Verma","year":"2007","journal-title":"J. Med. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Transverse Myelitis Consortium Working Group (2002). Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology, 59, 499\u2013505.","DOI":"10.1212\/WNL.59.4.499"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1053\/j.sult.2023.03.015","article-title":"Infectious Myelitis","volume":"44","author":"Miyoshi","year":"2023","journal-title":"Semin. Ultrasound CT MRI"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1038\/nrneurol.2015.121","article-title":"Lyme neuroborreliosis\u2014Epidemiology, diagnosis and management","volume":"11","author":"Koedel","year":"2015","journal-title":"Nat. Rev. Neurol."},{"key":"ref_15","first-page":"179","article-title":"Spinal cord involvement in bacterial infections","volume":"19","author":"McManus","year":"2004","journal-title":"J. Child Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1001\/archneur.58.5.806","article-title":"Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis","volume":"58","author":"Kastenbauer","year":"2001","journal-title":"Arch. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"263","DOI":"10.3343\/alm.2014.34.4.263","article-title":"Update on procalcitonin measurements","volume":"34","author":"Meisner","year":"2014","journal-title":"Ann. Lab. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Diallo, K., Feteh, V.F., Ibe, L., Antonio, M., Caugant, D.A., du Plessis, M., Deghmane, A.E., Feavers, I.M., Fernandez, K., and Fox, L.M. (2021). Molecular diagnostic assays for the detection of common bacterial meningitis pathogens: A narrative review. EBioMedicine, 65.","DOI":"10.1016\/j.ebiom.2021.103274"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Demaerel, P., and Cappelle, S. (2019). Neuroimaging in Inflammatory and Infectious Diseases of the Spinal Cord. Clinical Neuroradiology, Springer.","DOI":"10.1007\/978-3-319-68536-6_40"},{"key":"ref_20","first-page":"bcr2016215552","article-title":"Post-streptococcal reactive arthritis: Where are we now","volume":"2016","author":"Pathak","year":"2016","journal-title":"Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1128\/CMR.17.2.348-369.2004","article-title":"HLA-B27-associated reactive arthritis: Pathogenetic and clinical considerations","volume":"17","author":"Colmegna","year":"2004","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/6\/147\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T11:10:15Z","timestamp":1765192215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/6\/147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["idr17060147"],"URL":"https:\/\/doi.org\/10.3390\/idr17060147","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}