Overwhelming Postsplenectomy Infection Presenting as Acute Lower Limb Ischemia—A Case Report

Abstract

This report describes acute ischemia of the right lower extremity as the first sign of overwhelming postsplenectomy infection (OPSI) in a sixty-five-year-old man with known peripheral vascular disease two months after gastrectomy and splenectomy for gastric cancer. While emergency arterial bypass was being con sidered, the patient developed generalized peripheral vasoconstriction together with clinical and laboratory evidence of consumption coagulopathy and meta bolic acidosis. The possibility of OPSI was suggested and he was accordingly managed in the intensive care unit. A blood culture grew Streptococcus pneumo niae. The patient died of overwhelming pneumococcal sepsis with marked hemodynamic instability and multiorgan dysfunction four days after admission. The onset of acute lower limb ischemia was an early sign of OPSI in this patient with preexisting peripheral vascular disease. This sign has not been pre viously reported.