An overwhelming post-splenectomy infection (OPSI)

We present the case of a 25 year old man who had a splenectomy five years previously following a road traffic accident (RTA). He presented to our A&E department one evening with fever and upper abdominal pain associated with nausea and vomiting. Clinical examination was unremarkable. Initial investigations revealed only pyuria. He was treated symptomatically along with parenteral antibiotic and admitted to the general medical ward. Within few hours he deteriorated rapidly with septic shock, multi-organ failure, disseminated intravascular coagulation (DIC) and eventually cardio-respiratory arrest. Despite all resuscitative measures he died within few hours of admission. Splenectomized patients are prone to develop severe infection, including sepsis and meningitis, due to OPSI, or overwhelming post-splenectomy infection. Presentation may be mild, but the course is rapid and the prognosis is very poor, even in young people. It is important that splenectomized patients receive vaccines according to guidelines, take antibiotic prophylaxis and are educated to seek medical attention at the earliest sign of even minor infections.