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

Area of Science:

• Medical Case Study
• Infectious Disease
• Forensic Pathology

Background:

• Overwhelming post-splenectomy infection (OPSI) is a rare, fulminant, and often fatal syndrome following splenectomy.
• OPSI can occur years or even decades after the initial surgery, challenging timely diagnosis.

Purpose of the Study:

• To present a case of fatal OPSI in a patient with a remote history of splenectomy.
• To emphasize the importance of considering splenectomy in the chain of causation for deaths attributed to sepsis, regardless of the time elapsed.

Main Methods:

• Review of clinical records, laboratory studies, imaging, and medicolegal investigative records.
• Autopsy and toxicological examination (implied by medicolegal investigation).

Main Results:

• A 44-year-old male with a remote splenectomy history presented with septic shock and multiorgan failure.
• Blood cultures identified *Streptococcus pneumoniae*; the patient died within 29 hours of admission despite aggressive treatment.
• Cause of death certified as OPSI due to streptococcal sepsis; manner of death classified as accidental.

Conclusions:

• Fatal OPSI cases require medicolegal referral to determine the influence of the splenectomy indication on death certification.
• The time interval between splenectomy and fatal infection should not preclude its consideration as a causal factor.