Post-Sepsis Syndrome and Recovery Timeline in Immunocompromised Patient

Case at a Glance

A 56-year-old immunocompromised female with smoldering myeloma presented with rapid-onset sepsis secondary to Streptococcus pneumoniae bacteremia, complicated by severe tongue swelling and systemic inflammatory response. Despite successful treatment, she experiences persistent fatigue consistent with post-sepsis syndrome.

Patient's Story

The patient, who has a history of smoldering myeloma with immune paresis and is currently on methotrexate therapy, presented to the emergency department at 3 AM with severe tongue swelling that prevented mouth closure. The evening prior, she had experienced only mild throat discomfort and slight tongue swelling. She had no other preceding illness or symptoms.

Initial Assessment

Upon arrival to the emergency department, the patient presented with severe glossal edema preventing oral closure, hyperthermia unresponsive to acetaminophen, tachycardia, and hypoxemia. Given her immunocompromised state and constellation of symptoms suggestive of sepsis, blood cultures were obtained and empirical intravenous antibiotic therapy was initiated immediately.

The Diagnostic Journey

Initial blood cultures confirmed the presence of Streptococcus pneumoniae bacteremia, establishing the diagnosis of sepsis. The patient's immunocompromised status due to methotrexate therapy and underlying smoldering myeloma likely contributed to her increased susceptibility to invasive pneumococcal disease. Follow-up blood cultures obtained several days later demonstrated clearance of bacteremia, indicating appropriate antibiotic response.

Final Diagnosis

Primary diagnosis: Sepsis secondary to Streptococcus pneumoniae bacteremia with associated severe glossal edema. Secondary considerations: Post-sepsis syndrome with persistent fatigue. Underlying conditions: Smoldering multiple myeloma with immune paresis, currently on immunosuppressive therapy.

Treatment Plan

The patient received immediate empirical intravenous antibiotic therapy upon presentation, which was continued based on culture sensitivities. Supportive care included management of systemic inflammatory response and monitoring for complications. The treatment course was successful in clearing the bacteremia as evidenced by negative follow-up cultures.

Outcome and Follow-up

The patient achieved clinical recovery from the acute septic episode with documented bacterial clearance. However, she continues to experience significant persistent fatigue two weeks post-discharge. This presentation is consistent with post-sepsis syndrome, a well-recognized sequela that can persist for weeks to months, or in some cases years, particularly in immunocompromised patients. Patient education regarding the expected recovery timeline and the individual variability in post-sepsis syndrome duration was provided. Continued monitoring and supportive care are recommended, with attention to her underlying immunocompromised state and increased risk for future infections.