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Pneumococcal sepsis due to functional hyposplenism in a bone marrow transplant patient

M Elias1, N Bisharat, L H Goldstein

  • 1Department of Internal Medicine C, Central Emek Hospital, 18101 Afula, Israel. elias_m@clalit.org.il

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|February 27, 2004
PubMed

Insights

Patients with chronic graft-versus-host disease (GVHD) post-bone marrow transplant are at high risk for encapsulated bacterial infections. This case highlights recurrent pneumococcal sepsis due to functional hyposplenism, emphasizing the need for antibiotic prophylaxis strategies.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Immunology

Background:

  • Bone marrow transplantation (BMT) recipients, particularly those with chronic graft-versus-host disease (GVHD), face increased susceptibility to severe infections.
  • Encapsulated bacteria pose a significant threat in this immunocompromised population.

Observation:

  • A case of allogeneic BMT recipient with chronic GVHD who developed overwhelming pneumococcal sepsis three years post-transplant.
  • The patient experienced recurrent Neisseria infections despite immunoglobulin prophylaxis.
  • Functional hyposplenism was suspected due to the presence of Howell-Jolly bodies on peripheral blood smear.

Findings:

  • Recurrent encapsulated bacterial infections, including pneumococcal sepsis and Neisseria infections, occurred in a BMT recipient with chronic GVHD.
  • Functional hyposplenism was identified as a likely cause of recurrent infections, despite immunoglobulin replacement therapy.
  • The patient's history suggests a prolonged period of vulnerability to severe bacterial infections post-transplant.

Implications:

  • This case underscores the critical need for vigilant monitoring and management of infections in chronic GVHD patients after BMT.
  • It prompts a discussion on the optimal policy for antibiotic prophylaxis in this high-risk patient group.
  • Understanding the role of hyposplenism in BMT recipients is crucial for preventing severe, life-threatening infections.

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