title: [Overwhelming postsplenectomy infection 22 years after splenectomy].
abstract: A 25-year-old man undergoing splenectomy at 3 years of age to treat idiopathic thrombocytopenic purpura but no history of Streptococcus pneumonia vaccination, and reporting high fever, nausea, and headache developed purpura, confusion, and hypotension the next day and was admitted. Detailed examination showed disseminated intravascular coagulation and multiple-organ dysfunction. Chest X-ray and computed tomography (CT) showed pneumonia and pleural effusion. Blood culture was positive for S. pneumoniae. Gram staining of sputa yielded numerous white blood cells and gram-negative rods, and sputa culture was positive for Pasteurella multocida and Haemophilus influenzae. The medical history and presence of these organisms yielded a diagnosis of overwhelming postsplenectomy infection (OPSI), and the patient responded to treatment with a combination of benzylpenicillin, cefotaxime, and meropenem. This case suggests that patients with a history of splenectomy may benefit from vaccination for S. pneumoniae and adequate education on OPSI.
authors.affiliation: Department of Rheumatology, Infectious Diseases Medicine, Faculty of Medicine, University of Miyazaki.
authors.forename: Norio
authors.initials: N
authors.lastname: Kusumoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kuroki
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Umekita
authors.forename: Shiro
authors.initials: S
authors.lastname: Ueno
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takajo
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: Masami
authors.initials: M
authors.lastname: Shimada
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hidaka
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kubo
authors.forename: Syunnichi
authors.initials: S
authors.lastname: Miyauchi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okayama
mesh_terms: D000328:Adult; D006192:Haemophilus Infections / Q000209:etiology; D006193:Haemophilus influenzae; D006801:Humans; D008297:Male; D010326:Pasteurella Infections / Q000209:etiology; D016979:Pasteurella multocida; D011008:Pneumococcal Infections / Q000209:etiology*; D011183:Postoperative Complications; D018805:Sepsis / Q000209:etiology; D013156:Splenectomy; D013997:Time Factors