Overwhelming infection after splenectomy in spite of some spleen remaining and splenosis. A case report.
A fatal case of overwhelming postsplenectomy pneumococcal sepsis is presented occurring in a 37-year-old female 11 years after removal of the spleen because of traumatic rupture. The patient died 11 h after admission to hospital and about 32 h after sudden onset of illness. At necropsy splenic tissue, splenosis, disseminated intravascular coagulation, and thrombi within the arterioles consisting of gram-positive cocci and adrenal hemorrhage were found. The clinical, laboratory, and postmortem findings are described. Reports had been published of 41 other cases of overwhelming postsplenectomy infection (OPSI) in patients aged 20 years or more, but only three of these cases of OPSI syndrome occurred in spite of remaining splenic tissue. The longest interval between extirpation of spleen and subsequent sepsis was 42 years, indicating a small but lifelong risk of severe infection in asplenic patients. In view of the literature, the role of spleen in infection defence, the splenic function in blood clearance, and the prevention of postsplenectomy infections by antibiotic prophylaxis, pneumococcal vaccine, and reimplantation of autochthonous splenic tissue or infrared contact coagulation are discussed.
D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000473:pathology; D005260:Female; D006474:Hemorrhagic Disorders / Q000473:pathology; D006801:Humans; D014066:Palatine Tonsil / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology; D018805:Sepsis / Q000473:pathology; D012772:Shock, Septic / Q000473:pathology*; D013156:Splenectomy; D013161:Splenic Rupture / Q000601:surgery*; D013290:Streptococcal Infections / Q000473:pathology*; D013296:Streptococcus pneumoniae; D014069:Tonsillitis / Q000473:pathology*