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 oc currence 31 years postsplenectomy in a 35-year-old woman is the subjec t of this report. In spite of septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome, gastrointestinal he morrhage, and digital gangrene, the patient recovered with only minima l 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 determinants of her recovery. Int ravenous corticosteroids, fresh-frozen plasma, and packed red blood ce lls appeared to be beneficial as well. A diagnosis of hereditary spher ocytosis was made following recovery. This case is discussed in the li ght of guidelines for prophylaxis of overwhelming sepsis in high-risk patients issued by the Centers for Disease Control of the National Ins titute of Health. Vaccination with pneumococcal vaccine (23 valent) an d meningococcal vaccine is highly recommended for adults at high risk of overwhelming sepsis. This treatment should be repeated every 6 year s. It is critical that the patient, the doctor, and emergency room phy sicians be aware of the importance of prompt aggressive antibacterial treatment for any suspected infection.