# Treatment-Resistant Fulminant Septic Shock: A Case of Multidrug-Resistant Streptococcus pneumoniae Bacteremia in an Unvaccinated Intravenous Drug User

## TL;DR

A drug user with a severe, antibiotic-resistant Streptococcus pneumoniae infection developed fatal septic shock and ARDS, highlighting the dangers of antibiotic resistance and lack of vaccination.

## Contribution

This case highlights the clinical challenges of multidrug-resistant Streptococcus pneumoniae in intravenous drug users and the importance of vaccination.

## Key findings

- The patient had a multidrug-resistant Streptococcus pneumoniae infection resistant to ceftriaxone, azithromycin, and levofloxacin.
- Despite appropriate antibiotic treatment, the patient's condition rapidly deteriorated to multi-organ failure and death.
- The case emphasizes the role of vaccination in preventing severe infections in intravenous drug users.

## Abstract

This case report presents Streptococcus pneumoniae bacteremia in a 60-year-old male with a history of intravenous drug use (IDU), presenting with acute respiratory distress syndrome (ARDS). The patient experienced fever, malaise and myalgia for about a week. Chest imaging revealed diffuse bilateral infiltrates, and laboratory tests showed elevated inflammatory markers. His condition deteriorated abruptly, rapidly progressing to respiratory failure, shock, and ultimately death. Both sputum and blood cultures confirmed Streptococcus pneumoniae infection and revealed resistance to commonly used antibiotics, including ceftriaxone, azithromycin, and levofloxacin. Despite appropriate antibiotic therapy, the infection could not be controlled, and the patient’s condition deteriorated rapidly; he died on the fifth day of hospitalization due to multi-organ failure. The case underscores the challenges of managing sepsis and ARDS in IDU patients. Additionally, it emphasizes the growing issue of antibiotic resistance and importance of primary prevention, including vaccination, as a key strategy to reduce the incidence and severity of infections in IDUs.