A case report of bacteremia manifesting as an overwhelming postsplenectomy infection due to Streptococcus pneumoniae post vaccination.

Kosuke Hirose,Hirohisa Okabe,Yoshihiko Maehara,Tomoharu Yoshizumi,Hideo Baba,Norifumi Harimoto,Toru Ikegami,Hideaki Uchiyama,Shinji Itoh,Koichi Kimura

doi:10.1186/s40792-016-0173-2

Kosuke Hirose, Hirohisa Okabe + Show 8 more

Open Access

https://doi.org/10.1186/s40792-016-0173-2

Copy DOI

Abstract

A 62-year-old woman was admitted for acute epigastralgia and high-grade fever of over 39 °C. The patient had undergone splenectomy for idiopathic portal hypertension 1 year ago and vaccination against Streptococcus pneumoniae immediately post operation. She developed localized peritoneal irritation and abdominal distension. Her serum creatinine had increased to 1.5 mg/dL and procalcitonin was 12.5 ng/ml. Computed tomography of the abdomen revealed edematous large intestine and increased ascites. From these results, the patient was considered to have spontaneous bacterial peritonitis (SBP). Vancomycin (VCM) and doripenem (DRPM) were administered to control the infection. Unexpectedly, S. pneumoniae was detected in the blood culture. Hence, ampicillin/sulbactam was administered after discontinuing VCM. The patient recovered without any life-threatening complications and was discharged after 10 days. In conclusion, overwhelming postsplenectomy infection (OPSI) due to S. pneumoniae could develop in patient with splenectomy even after vaccination. Although the bacteremia probably due to SBP and acute renal dysfunction was accompanied by OPSI, our patient recovered rapidly.

Highlights

Overwhelming postsplenectomy infection (OPSI) is a serious disease with a high mortality rate, especially in patients with hematopoietic diseases [1]
Overwhelming postsplenectomy infection (OPSI) due to S. pneumoniae could develop in patient with splenectomy even after vaccination
We present a rare case of bacteremia probably due to spontaneous bacterial peritonitis (SBP) caused by S. pneumoniae after splenectomy and subsequent vaccination

Summary

Background

Overwhelming postsplenectomy infection (OPSI) is a serious disease with a high mortality rate, especially in patients with hematopoietic diseases [1]. We present a rare case of bacteremia probably due to spontaneous bacterial peritonitis (SBP) caused by S. pneumoniae after splenectomy and subsequent vaccination. The laboratory data was as follows: white blood cell count, 22.29 × 103/μL; serum creatinine, 1.55 mg/dL; prothrombin time (PT) activity, 21 %; and C-reactive protein, 7.57 mg/dL (Table 1). She was diagnosed with idiopathic portal hypertension 10 years ago and had undergone splenectomy a year ago. We did not perform the bacterial examination on ascites on admission, S. pneumoniae was detected in the blood culture on the following day. CT obtained a month after the discharge showed that ascites had decreased and the abnormal findings of the large intestine had disappeared (Fig. 1c, d)

Findings

Discussion

Conclusions