Ｗａｔｅｒｈｏｕｓｅ‐Ｆｒｉｄｅｒｉｃｈｓｅｎ症候群を合併したひ摘後重症感染症の１症例

Abstract

A case of “overwhelming postsplenectomy infection” is reported. The patient was a 34-year-old laborer who was splenectomized for trauma 5 years prior to the present illness. He went to work with a chill in the morning and came home with a high fever, vomiting and diarrhea at noon. Upon visiting an emergency center at 9p.m. that night, he was found to be in shock. In the ambulance on the way to our hospital, he became pulseless and unconscious. After a short period of stable blood pressure following CPR, he became hypotensive, and died the next morning. The initial examination showed that WBC, RBC and platelet counts were 8, 800, 520×104 and 1.7×104/mm3, respectively. Sepsis and DIG were suspected. Autopsy and blood culture revealed that the patient had developed pneumococcal sepsis and Waterhouse-Friderichsen syndrome. Immunochemical analysis showed that the amount of antibody to pneumococcal capsular polysaccharides had been reduced to a subnormal level. Splenectomized patients should be recognized as immunocompromized hosts and the high morbidity and mortality risk from sepsis in these patients should also be kept in mind.