Patrick J. Fahey

Overwhelming Sepsis and Bleeding in a Previously Splenectomized Patient

The occurrence of overwhelming sepsis due to Streptococcus pneumoniae infection is a rare but well- known complication of splenectomy. Its occurrence 31 years postsplenectomy in a 35-year-old woman is the sub ject of this report. In spite of septic shock, disseminated intravascular coagulation, adult respiratory distress syn drome, gastrointestinal hemorrhage, and digital gangrene, the patient recovered with only minimal loss of parts of digits. The use of high-dose penicillin empirically in the emergency room along with liberal use of resuscitative fluids and dopamine may have been the major determi nants of her recovery. Intravenous corticosteroids, fresh- frozen plasma, and packed red blood cells appeared to be beneficial as well. A diagnosis of hereditary spherocyto sis was made following recovery. This case is discussed in the light of guidelines for prophylaxis of overwhelming sepsis in high-risk patients issued by the Centers for Dis ease Control of the National Institute of Health. Vacci nation with pneumococcal vaccine (23 valent) and men ingococcal vaccine is highly recommended for adults at high risk of overwhelming sepsis. This treatment should be repeated every 6 years. It is critical that the patient, the doctor, and emergency room physicians be aware of the importance of prompt aggressive antibacterial treat ment for any suspected infection.