SHM Converge Scientific Abstract ePoster Gallery-Overwhelming Post-Splenectomy Infection (Opsi) Caused by Klebsiella Pneumoniae Treated With Continuous Antibiotic Infusion and Intravenous Immunoglobulin: A Case Report

Overwhelming Post-Splenectomy Infection (Opsi) Caused by Klebsiella Pneumoniae Treated With Continuous Antibiotic Infusion and Intravenous Immunoglobulin: A Case Report

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This case report describes a 64-year-old man with a remote history of splenectomy, performed at age four for idiopathic portal vein hypertension, who presented with dyspnea, anorexia, fever, tachycardia, tachypnea, leukocytosis, and bilateral pulmonary infiltrates on CT. He was diagnosed with sepsis from community-acquired pneumonia in the setting of asplenia, consistent with overwhelming post-splenectomy infection (OPSI).  <br /><br />OPSI is a rapidly progressive, life-threatening infection in asplenic patients, with reported mortality around 50%. The most common causative organisms are encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. In this patient, however, the pathogen was Klebsiella pneumoniae, an Enterobacteriaceae species that is a rare cause of OPSI.  <br /><br />Because of the severe and rapidly progressive nature of the illness, the authors used an aggressive treatment strategy including intravenous immunoglobulin (IVIG) and continuous antibiotic infusion. The rationale for IVIG was to enhance opsonization and phagocytosis, potentially improving host defense in an asplenic patient. The discussion notes that evidence for IVIG in OPSI is limited, with no strong randomized controlled trial data.  <br /><br />The use of continuous antibiotic infusion was informed by available observational data and recent trial evidence, including BLING III, though the literature does not clearly show superiority of continuous over intermittent infusion for mortality reduction.  <br /><br />The report emphasizes three key lessons: recognizing OPSI early in asplenic patients, understanding that rare pathogens such as K. pneumoniae can cause severe disease, and using the best available evidence— including case reports and observational studies—when randomized trial data are sparse for rare, critical conditions.

Asset Subtitle

Yoshihiro Kawata

Meta Tag

Author List Masaji Saijo, Myenog Cheol Song, Shadia S. Constantine, Tatsuya Yamada, Yoshihiro Kawata

Category Clinical Vignettes

Concept Overwhelming Post-Splenectomy Infection

Concept Asplenia

Concept Encapsulated Bacteria

Concept Streptococcus pneumoniae

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Sapporo Tokushukai Hospital

Presenting Author Yoshihiro Kawata

Track Adult

Keywords

overwhelming post-splenectomy infection

OPSI

asplenia

splenectomy

community-acquired pneumonia

Klebsiella pneumoniae

sepsis

intravenous immunoglobulin

continuous antibiotic infusion

encapsulated bacteria

Overwhelming Post-Splenectomy Infection

Asplenia

Encapsulated Bacteria

Streptococcus pneumoniae

Antibiotic Therapy