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Autosplenectomy

Published:January 05, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.008
      A 30-year-old woman manifested fatigue and high fever. She was diagnosed with antiphospholipid antibodies positive-systemic lupus erythematosus (SLE), but she had never demonstrated any serious organ involvements including nephritis and thrombosis, and had never received immunosuppressants. Physical examination demonstrated costovertebral tenderness and pyuria, and she was treated with cefaclor for uncomplicated pyelonephritis. After ten days, she visited our emergency room with the same manifestations and was improved equally by cefaclor. However, just after ten days, she was raced to our hospital again with a shock state. She demonstrated costovertebral tenderness and pyuria with an elevated level of procalcitonin. She was diagnosed with urosepsis despite undetectable culture-proved bacteria, and was treated with meropenem and vancomycin, achieving a clinical improvement. Computed tomography revealed calcified splenic atrophy which was not observed a decade ago (Fig. 1). We diagnosed the patient with functional asplenia by autosplenectomy. She was finally recovered with antibiotics and received vaccination for pneumococcus and Haemophilus influenzae type b to prevent further life-threating infection. Although we do not supply emergency antibiotics, she is still infection-free.
      Fig 1
      Fig. 1Gradual progress of autosplenectomy. Computed tomography revealed (A) calcified splenatrophy in the lupus patient with antiphospholipid antibody on axial and coronal planes (arrows), (B) as compared with a decade ago (arrow).
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