Thread by @IUIDfellowship

#idboardreview 25 F hx splenectomy presents w/ sudden onset of N, V, D, abd pain, Fever
rapid rash,⬆️Cr⬆️INR⬆️PT, respiratory fail, septic shock, b/l adrenal hemorrhage. Diagnosis? #medEd #idmedEd #IDtwitter

#streptococcus pneumoniae #pneumococcal sepsis, Waterhouse-Friderichsen syndrome, diffuse disseminated intravascular coagulation #DIC and #purpurafulminans

#purpurafulminans in asplenic patient DDX
Neisseria meningitidis,
Capnocytophaga,
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus,
Haemophilus influenzae
Babesia

#Pneumococcal infection is the most common cause of fulminant infection in the asplenic host. Old 1990 data suggested 3.2% incidence of sepsis after splenectomy over 6.9 years of follow-up but rates have dropped since universal immunization

asplenic patients can have a “pill-in-pocket”, referring to an anti-pneumococcal oral abx rapidly available to take at home at first onset of fever. Unfortunately pt didn’t received appropriate post-splenectomy vaccinations & didn’t have any abx available at home

#Waterhouse-Friderichsen syndrome is typically caused by Neisseria meningitidis, but has been reported in sepsis from
Streptococcus pneumoniae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Escherichia coli,
Haemophilus influenzae, and Staphylococcus aureus

academic.oup.com/qjmed/article/…

textbookofbacteriology.net/S.pneumoniae.h…