An Overwhelming Postsplenectomy Infection Syndrome Associated with Diabetes M ellitus

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A 72-year-old male diabetic patient was admitted due to autoimmune hemolytic anemia (AIHA).We started 1mg/kg weight of prednisolone daily and multiple daily insulin infusion for hyperglycemia.Gall bladder cancer and early stage gastric cancer were then diagnosed. We removed the gall bladderand the spleen for treatment of AIHA without prednisolone for better control of diabetes mellitus. Fiveweeks later, endoscopic gastromucosal resection (EMR) was performed for gastric cancer. The patientsuffered from fever and respiratory failure after 4 days. Chest computed tomography showed consolidation,bronchial wall thickening and a ground glass appearance in bilateral lungs. Although the sputumand blood culture were negative,β-D-glucan and mannan antigen increased. Neutrophilia (87％)wasshown. The WBC count had not increased (7300/μl) compared with the CRP elevation (21.8mg/dl).Therefore, we diagnosed overwhelming postsplenectomy infection syndrome followed by atypical pathogeninfection. We used ciprofloxacin and fosfluconazol, respirator at low tidal volume ventilation,sivelestat sodium hydrate and methylprednisolone for respiratory failure and regular insulin aiming fora blood glucose range of from 80 to 140mg/dl. The patient subsequently recovered
北関東医学会の論文