Fulminant sepsis in adults splenectomized for Hodgkin's disease

Laparotomy with splenectomy still remains important for staging Hodgkin's disease (HD). The risk of fulminant sepsis (FS) after splenectomy is well known, but the incidence of FS in splenectomized HD adult patients has not been accurately assessed. In this study we have tried to assess this risk and its duration and to evaluate the role of HD "per se" in causing FS.

Six cases of FS were traced in a group of 226 splenectomized adults, with a crude incidence of 2.65%. Age at the time of the event ranged from 23 to 41 years and time after splenectomy from 46 to 98 months. Four patients were disease-free when sepsis occurred. In 4 cases the causative agent was isolated (3 Streptococcus Pneumoniae, 1 Streptococcus alpha Haemolyticus). The mortality rate was 66%, while net probability of death (life table) at 10 years was 2.6%. M/F rate was 0/6 (P = 0.01). The incidence of FS was 0.33 cases per 100 patient-years (I.C. 95% = 0.12-0.72). There seems to be no relationship to histological type, clinical stage or age at splenectomy. No case of sepsis occurred in a control group of 281 non-splenectomized HD adults (P = < 0.01), despite the more advanced disease present in these cases on the average.

The frequency of FS, the causative agents, the mortality rate, the duration of risk are similar to those previously reported. Prompt treatment of any febrile disease in HD splenectomized patients and a policy of antipneumococcal (and possibly of anti-meningococcal) vaccination seem advisable.