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Horita T, Kosaka N, Takaoka S, Fujii G, Fujimoto K, Koshimizu Y, Kakuda T, Shojo H, Adachi N. Three Autopsy Cases of Non-Meningococcal Waterhouse-Friderichsen Syndrome with Hypoplastic Spleen or Post-Splenectomy Status. TOHOKU J EXP MED 2022; 258:287-301. [DOI: 10.1620/tjem.2022.j085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tetsuya Horita
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | | | - Shinya Takaoka
- Department of Gastroenterology and Hepatology, University of Yamanashi Hospital
| | - Gento Fujii
- Laboratory of Systems Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo
| | - Kana Fujimoto
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | - Yoshihito Koshimizu
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | - Tsuneo Kakuda
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | - Hideki Shojo
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | - Noboru Adachi
- Department of Legal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
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Anai S, Ibusuki R, Takao T, Okushima K, Sakurai Y, Hisasue J, Furukawa T, Shiraishi N, Takaki Y, Hara N. Splenic volume in pneumococcal pneumonia patients is associated with disease severity and mortality. J Infect Chemother 2020; 26:977-985. [PMID: 32376162 DOI: 10.1016/j.jiac.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
Splenectomy is a risk factor for serious pneumococcal disease like overwhelming post-splenectomy infection (OPSI). In healthy individuals with small spleen, fulminant pneumococcal infection similar to OPSI has been reported. Furthermore, it is reported that small spleen was associated with severe pneumococcal infection patients treated in an intensive care unit. However, the association between the small spleen and pneumococcal pneumonia was not investigated enough. We retrospectively analyzed patients with pneumococcal pneumonia who underwent computed tomography examination with measurement of the splenic volume at Harasanshin Hospital between 2004 and 2019. Data on their background characteristics, laboratory findings, and clinical courses were collected. 413 patients were included in the final analysis. The splenic volume was significantly lower in the moderate (P < 0.001), severe (P < 0.00005), and extremely severe (P < 0.001) pneumonia groups compared with the mild pneumonia group. Furthermore, the splenic volume was significantly lower in patients died within 30 days of pneumonia treatment (median of 73.49 versus 110.77 cm3, P < 0.005) or during hospitalization (median of 71.69 versus 111.01 cm3, P < 0.0005). Splenic volume <40 cm3 was significantly associated with mortality within 30 days and total hospital mortality as a risk factor in univariate analysis. Splenic volume <40 cm3 was an independent risk factor for mortality within 30 days (odds ratio: 5.0, 95% confidence interval: 1.2-21.1, P < 0.05) and total hospital mortality (odds ratio: 7.4, 95% confidence interval: 1.8-30.6, P < 0.01) in multivariate logistic regression analysis. These results suggest that small spleen is a risk factor for severity and mortality of pneumococcal pneumonia.
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Affiliation(s)
- Satoshi Anai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan.
| | - Ritsu Ibusuki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tomoaki Takao
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Kazuhiro Okushima
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yuko Sakurai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Junko Hisasue
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tatsuya Furukawa
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naotaka Shiraishi
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yoichi Takaki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naohiko Hara
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
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Yuhara T, Takemura H, Akama T, Yamane K, Sumida T. Necrotizing fasciitis caused byStreptococcus pneumoniaein mixed connective tissue disease. Mod Rheumatol 2014; 10:180-2. [DOI: 10.3109/s101650070029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Murad AA, Jeffers M, Tobin AM, Connolly M. Purpura fulminans in a patient with mixed connective tissue disease. BMJ Case Rep 2013; 2013:bcr-2012-007947. [PMID: 23370948 DOI: 10.1136/bcr-2012-007947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old lady was admitted to the intensive care unit with sepsis. She had a history of mixed connective tissue disease, Raynaud's syndrome and hypothyroidism. 2 days later, she developed a purpuric rash on her face and extremities with a livedoid background. Few days later, her distal fingers and toes became gangrenous which then had to be amputated. Laboratory investigations showed that she was coagulopathic and had multiple organ dysfunctions. Antiphospholipid antibodies were negative; however, protein C and antithrombin III levels were low. A skin biopsy showed fibrinoid necrosis in the vessel wall with microthrombi and red-cell extravasation. A diagnosis of purpura fulminans was made.
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Affiliation(s)
- Aizuri A Murad
- Dermatology Department, Adelaide and Meath Hospital, Dublin, Ireland
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Santilli D, Govoni M, Prandini N, Rizzo N, Trotta F. Autosplenectomy and antiphospholipid antibodies in systemic lupus erythematosus: a pathogenetic relationship? Semin Arthritis Rheum 2003; 33:125-33. [PMID: 14625820 DOI: 10.1016/s0049-0172(03)00004-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe a systemic lupus erythematosus (SLE) patient with functional asplenia and antiphospholipid syndrome (APS) and to review the literature to better define its pathogenesis and diagnosis, emphasizing a possible relationship with antiphospholipid antibodies (aPL). METHODS Descriptive report of 1 case and review of the literature by means of a MEDLINE search from 1966 to 2002. RESULTS A SLE patient presented with cutaneous vasculitis and an unexpected thrombocytosis which resulted from autosplenectomy. Subsequently, she developed full-blown APS. In the literature, autosplenectomy has been described only in 1 other case of APS secondary to SLE. However, clinical or laboratory features linked to aPL occurred in several other cases among the 17 cases reported with functional asplenia. CONCLUSIONS Autosplenectomy in SLE may be pathogenetically related to aPL. Thrombocytosis, unusual in SLE, may be a diagnostic clue of this condition. Pneumococcal vaccination is warranted to prevent life-threatening infections that frequently complicate this asplenia.
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Affiliation(s)
- Daniele Santilli
- Unità Operativa di Reumatologia, and Servizio di Medicina Nucleare, Università degli Studi di Ferrara, Ferrara, Italy and Azienda Ospedaliera-Universitara "Arcispedale S. Anna", Ferrara, Italy
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