Overwhelming Post-Splenectomy Infection: A Case Report With Cause and Manner of Death Considerations

Overwhelming post-splenectomy infection (OPSI), formerly known as post-splenectomy sepsis, is a rare clinical syndrome occurring following splenectomy. The clinical course is fulminant and frequently fatal, often characterized by a viral-like prodrome followed by acute sepsis and rapid clinical decline. Although OPSI most commonly occurs within the first several years after splenectomy, delayed presentations have been reported decades later.

Clinical records, laboratory studies, imaging findings, and medicolegal investigative records were reviewed in the evaluation of a 44-year-old man with a remote history of splenectomy who presented with fulminant septic shock.

The decedent presented with fever, hypotension, tachycardia, metabolic acidosis, thrombocytopenia, and multiorgan failure following a brief viral-like prodrome. Blood cultures grew Streptococcus pneumoniae. Despite aggressive resuscitative efforts, including intubation, vasopressor support, and broad-spectrum antibiotics, the patient died approximately 29 hours after hospital admission. The cause of death was certified as overwhelming post-splenectomy infection due to streptococcal sepsis following remote splenectomy for blunt abdominal trauma, with the manner of death classified as accidental.

Fatal OPSI cases should be referred to the appropriate medicolegal authority because the underlying indication for splenectomy may influence death certification and manner of death determination. The prolonged interval between splenectomy and terminal infection should not exclude consideration of splenectomy as part of the fatal chain of causation.

Death investigators should ascertain the indication for splenectomy, regardless of how remote, because it may directly inform the manner of death determination.