Abstract
A 30 years-old male was admitted to our hospital in 1985 with tonsilitis and fever. Because anti-neutrophil antibody was detected by cytotoxic assays, we diagnosed that he had autoimmune neutropenia (AIN). After treatment with predonisolone (60_??_100mg/day) for 34 days, neutrophil count (66/mm3) gradually returned to normal level, but abruptly platelet count abruptly decreased to 4, 000/mm3. Because platelet associated IgG turned positive at the level of 63.4ng/107 cells, we diagnosed he had combined immunocytopenia.
Since any therapeutic trial was not responded with beneficial effects for thrombocytopenia, splenectomy and partial spleen autograft implantation (splenosis) were performed. Platelet and neutrophil counts were markedkly increased after the operation. He died of overwhelming post-splenectomy infection syndrome (OPSI) one week after the discharge. Autopsy revealed that his implanted spleens were intact. There were slight intravascular coagulation lesions in the lung and the kidney. Peptostreptococcus was detected from the blood specimen.
Fulminant bacterial infection called OPSI is reported in the splenectomized patients. It has been demonstrated that splenectomy is responsible for alteration in host defense especially opsonization and phagocytosis against bacteria. In this point of view, we performed splenosis not to deteriorate host defense mechanism. However, it is further recommended that the bacterial vaccination should be administrated to reduce the risk of OPSI.
