Occurrence of autosplenectomy in a survivor of pneumococcal purpura fulminans

A 44-year-old man presented to an emergency department with high fever and sore throat. He had no medical history other than pneumococcal purpura fulminans resulting in partial amputation of limbs 18 months prior. During his previous 6-month hospitalization period for the treatment of pneumococcal infection, Howell–Jolly bodies, the principal marker of functional asplenia, were consistently positive (Fig. 1A, arrow), despite the normal-sized spleen (Fig. 1B). He received pneumococcal vaccine on discharge.

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A, B, Peripheral blood smear showing Howell–Jolly body (A, arrow) suggestive of functional asplenia and an abdominal computed tomography scan (B) with normal-sized spleen at the time of admission of a 44-year-old man for fulminant pneumococcal septic shock. C, Chest computed tomography undertaken 18 months later incidentally revealed residual splenic remnant (arrow).

Upon examination in the emergency department, the patient had a body temperature of 40.3°C and enlarged palatine tonsils and cervical lymph nodes, suggestive of tonsillitis. Howell–Jolly bodies were still positive at this emergency visit. Chest computed tomography incidentally revealed a drastic decrease in the size of his spleen (Fig. 1C, arrow); thus, he was diagnosed with autosplenectomy.

To our knowledge, there have been only two reported cases of autosplenectomy after pneumococcal sepsis.1, 2 The speculated mechanism was septic microangiopathy in the spleen after pneumococcal septic shock1, 2; however, this case raised a possibility that the patient experienced fulminant pneumococcal infection during anatomical autosplenectomy. Regardless of whether the infection is the cause of autosplenectomy, these patients still require pneumococcal vaccination for vanishing spleen.

Approval of the research protocol: N/A.

Informed consent: Published with the written consent of the patient.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

Conflict of interest: None.

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