{
  "abstract": "A fully immunised two-and-a-half-year-old girl presented with fever, purpura, reduced consciousness and hypotension (65/48 mm Hg) from septic shock. She required intubation, intravenous fluids, ceftriaxone and an epinephrine infusion. Streptococcus pneumoniae was detected on blood PCR. Molecular identification of the serotype directly from blood was unavailable, and blood cultures, taken after antibiotic administration, were sterile. Chest X-ray revealed dextrocardia, confirmed on echocardiography. Ultrasound showed situs inversus with asplenia. Following recovery, she was started on penicillin V prophylaxis. She had no dysmorphic features, limb or other organ anomalies. Apart from Howell-Jolly bodies, the full immunological profile was normal and HIV testing was negative. At 7 years, she developed limb deformities (figure 1). X-rays showed premature epiphyseal fusion of the left radius and right tibia (figure 2), confirmed on MRI, necessitating epiphysiodesis (growth plate fusion).",
  "authors": [
    {
      "affiliations": [
        "Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta"
      ],
      "name": "Michela Galea"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Mater Dei Hospital, Msida, Malta"
      ],
      "name": "Massimo Abela"
    },
    {
      "affiliations": [
        "Department of Orthopaedics, Mater Dei Hospital, Msida, Malta"
      ],
      "name": "Sharon Zammit"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta"
      ],
      "name": "David Pace"
    }
  ],
  "title": "Pneumococcal sepsis and subsequent limb deformities",
  "uid": "bfec8c9d-c1f4-590e-8c24-84e810d287af"
}