Necrotizing fasciitis caused by Streptococcus pneumoniae

A 71-year-old Japanese man noticed a painful swelling on his right arm in 2015. He was admitted with a decreased levelof consciousnessand hypotension five days later. He had been suffering from viral liver cirrhosis. His history of pneumococcal vaccinationwas unclear. On admission, the levelof consciousnesswas E4V3M4 on the Glasgow Coma Scale; fever (37.5C), hypotension (93/62 mmHg), tachycardia (120 beats/min), and dyspnoea, due to acute respiratory distresssyndrome (not caused by bacterial [...]