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Autosplenectomy in systemic lupus erythematosus
I Uthman1, J P Soucy, V Nicolet
1Department of Medicine, Hôpital Notre-Dame, Montréal, Québec, Canada.
The Journal of Rheumatology
|October 1, 1996
Summary
Systemic lupus erythematosus (SLE) patients with autosplenectomy face high sepsis risk. Prompt pneumococcal vaccination significantly reduced infection rates in observed SLE patients, highlighting vaccine importance.
Area of Science:
- Immunology
- Rheumatology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease.
- Autosplenectomy, or spleen loss, in SLE patients increases susceptibility to infections, particularly Streptococcus pneumoniae sepsis.
- This complication is associated with significant mortality.
Observation:
- Two cases of autosplenectomy in SLE patients during acute exacerbations are presented.
- Both patients maintained a persistent absence of the spleen over extended follow-up periods (12 and 5.5 years).
- These patients received the 23-valent pneumococcal vaccine.
Findings:
- Despite the absence of a spleen, neither patient developed life-threatening infections during follow-up.
- This contrasts sharply with reported infection rates of 46.7% in asplenic SLE patients.
- The findings suggest a protective effect of pneumococcal vaccination.
Implications:
- The 23-valent pneumococcal vaccine should be administered promptly to SLE patients diagnosed with autosplenectomy.
- Early vaccination may mitigate the high risk of severe pneumococcal infections in this vulnerable population.
- This strategy could improve outcomes for SLE patients with spleen dysfunction or absence.