Unusual presentation of Streptococcus pneumoniae-induced septic shock 36 years after splenectomy

Excerpt

The lifetime risk of post-splenectomy patients to develop an overwhelming post-splenectomy infection (OPSI) with encapsulated bacteria, namely, Streptococcus pneumoniae, Haemophilus influenzae or Neisseria meningitidis is about 1–5% [1, 2]. Therefore, vaccination against those bacteria is mandatory following elective or emergency splenectomy. The recommended time frame of post-splenectomy vaccination is 2 weeks [3]. In the case of OPSI, mortality rate ranges between 40 and 70% [1], with a peak among patients with underlying haematological malignancies [4]. Despite updated guidelines describing the appropriate management of splenectomised patients [5], OPSI is still a major medical problem, with the highest incidence between 10 and 30 years after splenectomy [4]. It is of utmost importance to identify asplenic patients in case of a medical emergency. Respective alert cards could provide important information on the patient’s past history [6], which might enable early goal-directed therapy in case of an infection [7]. …