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Pneumococcal Infection in an Arteriovenous Fistula in an Adolescent with Renal Failure

A 17-year-old male was admitted because of a wound infection at the site of a brachiocephalic arteriovenous fistula 10 days after its placement. He had been diagnosed with focal segmental glomerulosclerosis (FSGS) at age 10 years, had progressed into renal failure at age 12 years, had undergone bilateral nephrectomy for refractory proteinuria and hypoalbuminemia, and subsequently had received an HLA identical kidney from a brother. He had not undergone a splenectomy. Two weeks posttransplant, he developed proteinuria attributed to recurrent FSGS, which subsequently resolved with high-dose cyclosporin. He had been fully vaccinated but had not received the pneumococcal vaccine. He had not had any previous pneumococcal infections and was not receiving any antibiotics except for daily trimethoprim-sulfamethoxazole, which was given posttransplant for Pneumocystis carinii prophylaxis. Four years posttransplant, he