We reviewed 71 consecutive patients with Streptococcus pneumoniae bacteremia. The patients were analyzed by age, sex, ethnic background, and clinical presentation. Laboratory data reviewed included a CBC count, electrolyte levels, liver function studies, chest radiograph, HIV status, a sputum culture and Gram's stain, and sensitivities for the S pneumoniae isolated. Modalities of therapy, response to treatment, and ultimate outcome were examined. Many of the patients with pneumococcal bacteremia did not have cough, fever, or chills. HIV positivity was a risk factor for pneumococcal infection although it was not associated with increased mortality. Mortality correlated with elderly status, leukopenia, and lack of fever. Many patients had symptoms suggestive of atypical pneumonia including myalgia and mental status change. Hyponatremia and hyperbilirubinemia were commonly noted.