The risk of overwhelming septicaemia, most commonly due to encapsulated organisms, is well recognised post-splenectomy. Although a similar risk is documented in hyposplenic patients, many physicians do not routinely give prophylaxis here. We report the case of a 41 year old woman with adult onset coeliac disease who developed pneumococcal meningitis resulting in severe residual disability and suggest that prophylaxis should be given to such individuals who have evidence of reduced splenic function.
BakerPGJonesJVPeacockDBReadAE. The immune response to 0X 174 in man.111. Evidence for an association between hyposplenism and immunodeficiency in patients with coeliac disease. Gut1975; 16: 538–542.
2.
SullivanJLOchsHDSchiffmanG.Immune response after splenectomy. Lancet1978; i: 178–181.
PettitJE. Spleen function. Clinics in Haematol.1977; 6: 639–656.
5.
KentGMinickOTVoliniFIOrfeiE.Autophagic vacuoles in human red cells. Am J Path1966; 48: 831–857.
6.
PearsonHASpencerRPCorneliusEA. Functional asplenia in sickle cell anaemia. NEJM1969; 281: 923–926.
7.
MarshGWStewartJS. Splenic function in adult coeliac disease. Brit J Haem1970; 19: 445–457.
8.
RyanFPSmartRCHoldsworthCDPrestonFE. Hyposplenism in inflammatory bowel disease. Gut1978; 19: 50–5.
9.
PettitJEHoffbrandAVSeahPPFryL.Splenic atrophy in dermatitis herpetiformis. BMJ1972; ii: 438–440.
10.
DillonAMSteinHBEnglishRA. Splenic atrophy in systemic lupus erythematosus. Annals of Internal Medicine. 1982–96: 40–43.
11.
MarshGWLewisSMSzurL.The use of 51Cr labelled heat damaged red cells to study splenic function. Brit J Haem1966; 12: 167–171.
12.
CorazzaGRGasbarriniG.Defective splenic function and its relation to bowel disease. Clinics in Gastroenterol.1983; 12: 651–659.
13.
CorazzaGRBullenAWHallRRobinsonPJLosowskyMS. Simple method of assessing splenic function in coeliac disease. Clin Sci1981; 60: 109–113.
14.
PalmerKRSherrifSVHoldsworthCD. Changing pattern of splenic function in coeliac disease. Gut1980; 20: A920.
15.
CorazzaGRLazzariRFrisoniMCollinaAGasbarriniG.Splenic function in childhood coeliac disease. Gut1982; 23: 415–416.
16.
SmartLEDougallAJGirdwoodRWA. New 23-valent pneumococcal vaccine in relation to pneumococcal serotypes in systemic and non-systemic disease. J Infect.1987; 14, 3: 209–216.
17.
AmmannAJAddiegoJWaraDWLubinBSmithWBMentzerWC. Polyvalent pneumococcal polysaccharide immunization of patients with sickle cell anaemia and patients with splenectomy. N Engl J Med1977; 297: 897–900.
18.
When to use the new pneumococcal vaccine. Drug Ther Bull.1990; 28 (8): 31–32.