Abstract
Encapsulated bacteria can cause severe infections following bone marrow transplantation, usually in patients with chronic graft-versus-host disease (GVHD). Presented here is the case of an allogenic bone marrow transplantation recipient with chronic GVHD who developed overwhelming pneumococcal sepsis 3 years following transplantation. One year earlier the male patient had developed non-meningococcal, non-gonococcal neisseria infection. The infection recurred repeatedly despite monthly replacement immunoglobulin prophylaxis. These infections were attributed to functional hyposplenism after a prominent number of Howell-Jolly bodies was noticed in a peripheral blood smear during the patient’s most recent admission. The case report is followed by a discussion of the policy of administering antibiotic prophylaxis to patients with chronic GVHD.
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References
Burik JV, Weisdorf D (2000) Infections in recipient of bone marrow transplantation. In: Mandell GL, Bennett JE, Dolin R (ed) Principles and practice of infectious diseases. Churchill Livingstone, New York, pp 3136–3147
Roy V, Ochs L, Weisdorf D (1997) Late infections following bone marrow transplantation: suggested strategies for prophylaxis. Leuk Lymphoma 26:1–15
Winston DJ, Schiffman G, Wang DC, Feig SA, Lin CH, Marso EL, Ho WG, Young LS, Gale RP (1979) Pneumococcal infections after human bone-marrow transplantation. Ann Intern Med 91:835–841
Hammarstrom V, Pauksen K, Svensson H, Longvist B, Simonsson B, Ringden O, Ljungman P (2000) Serum immunoglobulin levels in relation to levels of specific antibodies in allogenic and autologous bone marrow transplant recipients. Transplantation 69:1582–1586
Robertson DAF, Bullen AW, Hall R, Losowsky MS (1983) Blood film appearance in hyposplenism of celiac disease. Br J Clin Pract 37:19–22
Knecht H, Jost R, Gmur J, Burger J, Fehr J (1988) Functional hyposplenia after allogenic bone marrow transplantation is detected by epinephrine stimulation test and splenic ultrasonography. Eur J Haematol 41:382–387
Kalhs P, Panzer S, Kletter K, Minar E, Stain-Kos M, Waltter K, Lechner K, Hinterberger W (1988) Functional asplenia after bone marrow transplantation. A late complication related to extensive chronic graft versus host disease. Ann Intern Med 109:461–464
Picardi M, Selleri C, Rotoli B (1999) Spleen sizing by ultrasound scan and risk of pneumococcal infections in patients with chronic GVHD: preliminary observations. Bone Marrow Transplant 24:173–177
Cuthbert RJG, Iqbal A, Gates A, Toghill PG, Russell NH (1995) Functional hyposplenism following allogenic bone marrow transplantation. J Clin Pathol 48:257–259
Centers for Disease Control and Prevention (2000) Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR 49(RR10):1–128
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Elias, M., Bisharat, N., Goldstein, L.H. et al. Pneumococcal Sepsis due to Functional Hyposplenism in a Bone Marrow Transplant Patient. Eur J Clin Microbiol Infect Dis 23, 212–214 (2004). https://doi.org/10.1007/s10096-003-1091-3
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DOI: https://doi.org/10.1007/s10096-003-1091-3