Pneumococcal sepsis due to functional hyposplenism in a bone marrow transplant patient.
Encapsulated bacteria can cause severe infections following bone marrow transplantation, usually in patients with chronic graft-versus-host disease (GVHD). Presented here is the case of an allogenic bone marrow transplantation recipient with chronic GVHD who developed overwhelming pneumococcal sepsis 3 years following transplantation. One year earlier the male patient had developed non-meningococcal, non-gonococcal neisseria infection. The infection recurred repeatedly despite monthly replacement immunoglobulin prophylaxis. These infections were attributed to functional hyposplenism after a prominent number of Howell-Jolly bodies was noticed in a peripheral blood smear during the patient's most recent admission. The case report is followed by a discussion of the policy of administering antibiotic prophylaxis to patients with chronic GVHD.
Department of Internal Medicine C, Central Emek Hospital, 18101 Afula, Israel. elias_m@clalit.org.il
M
M
Elias
N
N
Bisharat
L H
LH
Goldstein
R
R
Raz
W
W
Saliba
D000328:Adult; D000900:Anti-Bacterial Agents; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000601:surgery; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D013158:Splenic Diseases / Q000150:complications / Q000175:diagnosis*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D006854:Hydrocortisone