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Background: Patients with systemic lupus erythematosus are at increased risk of serious or invasive Streptococcus pneumoniae infection due to intrinsic disease factors and concomitant immunosuppressive therapies. S. pneumoniae infections can be prevented with currently-available immunisation. Case report & results: A 37-year-old female of Malaysian origin with known systemic lupus erythematosus (SLE) presented to a district general hospital with pyrexia, cough and a rash. Streptococcus pneumoniae belonging to the serotype 22F was grown in blood cultures. The patient was treated with appropriate antibiotics and discharged. The patient was readmitted 3 weeks later with another Streptococcus pneumoniae bacteraemia belonging to a different serotype, 15A. Antibiotic therapy was given, and immunosuppressive treatment temporarily suspended. The patient was given 23-valent pneumococcal vaccination with a good immunological response and commenced on prophylactic amoxicillin. Conclusion: This case emphasises the importance of taking a complete vaccination history and ensuring full concordance with recommended vaccinations. There is a high burden of infectious disease in SLE; timely vaccination and risk assessment is recommended and consideration of prophylactic antibiotics in certain cases are therefore warranted following diagnosis of SLE.