Fulminant pneumococcal bacteremia in an asplenic chronic hemodialysis patient

A chronic hemodialysis patient, previously splenectomized because of trauma in conjunction with gastrectomy, developed bacteremia with type 18 Streptococcus pneumoniae and died within 13 hours of onset of symptoms. Characteristics of this illness were severe hypoglycemia, pneumococci visible on peripheral blood smear, disseminated intravascular coagulation, neutropenia, and in vitro hemolysis. Splenectomy should be considered with caution in uremic patients and in renal transplant recipients because of the increased risk of fulminant bacteremia. Polyvalent pneumococcal vaccine may be helpful in preventing this syndrome in such asplenic patients.