FINGER CELLULITIS DUE TO PNEUMOCOCCUS BY HEMATOGENOUS DISSEMINATION: CASE REPORT

Soft tissue infection in infants, especially preterm infants, can lead to serious complications such as ischemia. We report the case of a 4-month-old infant, born at 32 weeks’ gestation, who presented with hyperemia, edema, and fever affecting the third finger of the right hand, with no history of trauma, initially raising suspicion of fracture. Imaging ruled out fracture and revealed signs of infection. The patient was admitted and underwent surgical debridement and fasciotomy due to digital ischemia. Empiric antibiotic therapy with oxacillin was initiated and later switched to vancomycin after culture confirmation of infection by Streptococcus pneumoniae, an uncommon pathogen in cellulitis but potentially serious, especially in immunocompromised patients such as preterm infants. The patient remained in the pediatric ICU for 24 hours, with intensive monitoring and use of a central venous catheter, showing good clinical evolution with progressive improvement of the infectious process, reduction in edema, and normalization of laboratory tests. She was discharged after 15 days in good general condition. This case underscores the importance of early recognition of severe infection signs and the adoption of a multidisciplinary approach involving pediatrics, infectious diseases, and surgery to ensure favorable outcomes in vulnerable patients. Appropriate management with early surgical intervention and targeted antibiotic therapy, supported by current literature, was essential to avoid complications such as tissue necrosis and sepsis. Despite the rarity of pneumococcal etiology in pediatric cellulitis, this case broadens the spectrum of agents to be considered in the differential diagnosis and reinforces the need for clinical protocols that prioritize rapid and integrated action.