A case report of bacteremia manifesting as an overwhelming postsplenectomy infection due to Streptococcus pneumoniae post vaccination.
A case report of bacteremia manifesting as an overwhelming postsplenectomy infection due to Streptococcus pneumoniae post vaccination.
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DOI：
10.1186/s40792-016-0173-2
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发表时间：
2016-12
影响因子：
0.8
通讯作者：
Maehara Y
中科院分区：
文献类型：
--
作者：
Hirose K;Okabe H;Yoshizumi T;Uchiyama H;Ikegami T;Harimoto N;Itoh S;Kimura K;Baba H;Maehara Y
一名62岁女性因急性胃痛和39°C以上高热入院。患者1年前因特发性门静脉高压症行脾切除术，术后立即接种肺炎链球菌疫苗。她出现局部腹膜刺激和腹胀。血清肌酐升高至1.5 mg/dL，降钙素原12.5 ng/ml。腹部电脑断层显示大肠水肿及腹水增加。从这些结果来看，患者被认为是自发性细菌性腹膜炎（SBP）。应用万古霉素（VCM）和多利培南（DRPM）控制感染。出乎意料的是，在血培养中检测到肺炎链球菌。因此，在停止VCM后给予氨苄西林/舒巴坦。患者无任何危及生命的并发症，10天后出院。结论：脾切除术患者接种疫苗后仍可能发生肺炎链球菌所致的压倒性脾切除术后感染。虽然可能由收缩压和急性肾功能不全引起的菌血症伴有OPSI，但我们的患者恢复得很快。
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.