Fever and asplenia: a dangerous association

Description

A 77-year-old splenectomised woman presented with temperatures reaching 38.5°C in the last 24 hours. The clinical presentation was non-specific and blood tests came back normal: a diagnosis of acute gastroenteritis was made. The patient's clinical state then deteriorated rapidly; she developed septic shock, acute renal failure, disseminated intravascular coagulation and purpura fulminans with peripheral necrosis of toes and fingers (figure 1 A,B), as complications of a pneumococcaemia. Following appropriate antibiotic therapy and supportive care, the patient recovered but had to undergo transmetatarsal and finger amputations(figure 1 C,D).

Figure 1

Necrosis of the (A) toes and (B) fingers in the context of disseminated intravascular coagulation. Clinical evolution following (C) transmetatarsal and (D) finger amputations.

Fever in patients with asplenia can be the initial, and sometimes sole, sign of a severe infection. It should never be trivialised. Moreover, other clinical...

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