From ER to Mortality in 48 Hours: A Fatal Case of Overwhelming Post-Splenectomy Infection

Overwhelming post-splenectomy infection (OPSI) is a known complication of asplenia.1,2 While the precise rates of morbidity and mortality are unknown, estimates range from 38% to as high as 70%.2 Because the spleen plays an important role in protecting against infections with encapsulated microorganisms, OPSI is most commonly caused by infection with encapsulated bacteria, specifically Streptococcus pneumoniae.1–3 While pneumococcal vaccines have been shown to improve immunogenicity in asplenic people, OPSI remains a danger to both vaccinated and unvaccinated patients.4,5 Additional measures to protect asplenic patients from overwhelming infection have been proposed, but the evidence remains mixed.6–8 Prophylactic antimicrobial therapy has been recommended for certain populations, specifically children under five years old or adults during the first year post-splenectomy, but to our knowledge, no evidence-based guidelines currently exist.7,9 Studies have also considered intravenous immunoglobulin (IVIG) for the acute treatment of pneumococcal infection in asplenic patients. However, while IVIG has shown promise in mouse models and some preliminary human studies, it has not been conclusively studied.8,10,11 We describe a rapidly progressive and ultimately fatal case of overwhelming pneumococcal infection in an asplenic patient, with a discussion of presentation and management.