Abstract
A 64-year-old female who had undergone splenectomy combined with total gastrectomy for advanced gastric cancer in 2005 followed by adjuvant S-1 chemotherapy was admitted to our hospital because of high fever, diarrhea and mental confusion in January 2008. On the second day following admission, neck stiffness developed, and examination of cerebrospinal fluid (CSF) showed pleocytosis up to 17,400 cells/mm3 and elevated protein level of 572mg/dl. Haemophilus Influenzae was isolated from CSF and blood. We diagnosed the case as overwhelming postsplenectomy infection (OPSI) syndrome due to Haemophilus Influenzae meningitis. After administration of dexamethasone (8mg/day) and cefmetazole (2g/day) followed by meropenem (2g/day) and then ceftriaxone (4g/day), she survived without any sequelae. She was discharged from the hospital on the 50th hospital day.
Although Haemophilus Influenzae is a common cause of meningitis in children, adult case of OPSI caused by Haemophilus Influenzae is rarely reported. Splenectomized patients have been recognized as immunocompromized hosts, for whom fluminant bacterial infection can be associated with high morbidity and mortality. Therefore, early diagnosis and urgent treatments are important to reduce the mortality of such infections. To prevent OPSI, adequate vaccination and prophylactic administration of antibiotics seem to be effective. Moreover, physicians should always be aware of the onset of OPSI and educate the splenectomized patients and their families about OPSI so as to seek medical attention at the earliest signs of the infection.
