[Overwhelming postsplenectomy infection during combination therapy with interferon ribavirin after living donor liver transplantation for hepatitis C: a case report].
A 60-year old woman was admitted for reintroduction of interferon/ribavirin combination therapy to prevent the recurrence of hepatitis C following living donor liver transplantation (LDLT). She had also undergone splenectomy during LDLT to avoid postoperative pancytopenia due to hypersplenism. However, a few days after reintroduction of the therapy, she developed severe diarrhea and fever that progressed to circulatory and respiratory shock. Blood culture was positive for Streptococcus pneumoniae, leading to a diagnosis of overwhelming postsplenectomy infection (OPSI). Although the patient developed multi-organ failure, she ultimately recovered after intensive care including mechanical ventilation and hemodialysis. Once OPSI is suspected, intensive care should be commenced immediately given the disease' s fulminant clinical course and high mortality. Postoperative prophylaxis with the pneumococcal vaccine needs to be tested in a multi-center study.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences.
Manpei
M
Yamashita
Akihiko
A
Soyama
Mitsuhisa
M
Takatsuki
Masaaki
M
Hidaka
Hisamitsu
H
Miyaaki
Tamotsu
T
Kuroki
Kazuhiko
K
Nakao
Susumu
S
Eguchi
D003422:Critical Care; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage*; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000209:etiology*; D011183:Postoperative Complications; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage*; D013156:Splenectomy / Q000009:adverse effects
D012254:Ribavirin; D007372:Interferons