Abstract
A man in his twenties who had undergone splenectomy 5 years previously was admitted to our hospital in a shock state, with a history of high grade fever, vomiting, diarrhea and a washed out feeling since the previous day. His consciousness level deteriorated rapidly after admission, and based on the clinical findings and the results of investigations, he was diagnosed as having meningitis caused by penicillin-resistant Streptococcus pneumoniae. Despite aggressive treatment with antibiotics, intravenous immunoglobulin, steroids, etc., his condition deteriorated rapidly and he died on the 8th day of the illness. Splenectomy predisposes to infections by bacteria possessing a peroxidase (POD) membrane, which can cause meningitis and fulminant sepsis. Therefore, patients who have undergone splenectomy as well as their families must be made aware of this predisposition to severe infections and be urged to seek urgent medical attention even for mild symptoms of infection. In addition, preventive measures, such as vaccination with a pneumococcal vaccine should be strongly considered in these patients. Because some of these bacterial strains causing severe infections may be penicillin-resistant, careful choice of antibiotic therapy is required.
