Intravascular hemolysis associated with serum IgM cold agglutinins is
a recognized complication of pulmonary infection with Mycoplasma pneum
oniae. However, the syndrome has not been recognized as a sequela of i
nfection with Streptococcus pneumoniae. We report what we believe repr
esents the first case of pneumococcal pneumonia presenting with severe
intravascular cold agglutinin-mediated hemolysis requiring intensive
care admission and transfusion of multiple units of packed red blood c
ells.