An unusual case of occult pneumococcal bacteremia is reported. A 4-month-old female presented with ascending purpura on the lower extremities as the only abnormal physical finding. All initial laboratory studies were normal; however, Streptococcus pneumoniae serotype 6 was cultured from her blood within 18 hours and subsequently from the nasopharynx. This is the first reported case in humans of occult pneumococcal bacteremia presenting with the primary clinical finding of purpura. This entity has a well defined animal model in mice.
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