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A 37-year-old Japanese woman was referred to our institute with a 1-day history of a fever and altered mental status. Physical examinations revealed non-palpable purpura on her face, trunk, and extremities (Picture 1, ,2).2). Blood tests revealed marked thrombocytopenia and hypofibrinogenemia. A detailed chart review showed that she had undergone splenectomy 10 years prior and had not been vaccinated against pneumococcus. A lumbar puncture revealed pleocytosis suggesting meningitis, and her blood cultures were positive for Streptococcus pneumoniae. A diagnosis of purpura fulminans (PF) and overwhelming postsplenectomy infection (OPSI) due to pneumococci was established. After therapy with ceftriaxone, she recovered, and the purpura diminished.
Asplenic people are susceptible to severe infections due to encapsulated bacteria, such as S. pneumoniae, and develop OPSI, a life-threatening entity (1). Pneumococcus develops both PF and OPSI. PF and OPSI more frequently develop in septic patients with asplenia than in those with intact spleen (2). Physicians need to be aware that purpura may be the only sign of OPSI in asplenic patients.
The author would like to thank Ms. Ryoko Yoshida for editing the pictures.