[A survival case of fluminant meningitis and multiple organ failure as overwhelming postsplenectomy infection (OPSI) syndrome]

Abstract

A 39-year-old man, who had splenectomy following abdominal trauma 30 years previously, admitted to our hospital with high fever, headache and convulsion on January 8, 2002. Examination of cerebrospinal fluid (CSF) showed pleocytosis up to 10,000 cells/mm3 with polymorphonuclear cells dominant and elevated protein to 330 mg/dl and reduction of glucose to 15 mg/dl. Streptococcus pneumoniae was detected at the culture of CSF and blood. We diagnosed him as having pneumococcal meningitis as overwhelming postsplenectomy infection(OPSI) syndrome. After administration of carbapenem antibiotics, methylprednisolone (1,000 mg) and immunoglobulin, he survived without any complications. Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called OPSI syndrome. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. It is important for splenectomized patients to receive the vaccine, antibiotic prophylaxis and seek medical attention at the earliest sign of minor infection.