INTRODUCTION

Sepsis is a clinical syndrome resulting from the invasion of microorganisms into the body, causing a considerable systemic inflammatory response. Streptococcus pneumoniae is a gram-positive bacterium and the most common cause of pneumonia and meningitis. The spleen plays a crucial role in eliminating bacteria from the bloodstream. In individuals without a spleen or with its functional hyposplenism, there is a high risk of developing fulminant sepsis with potentially fatal outcomes.

CASE REPORT

A 36-year-old man was presented to the emergency department at 1:00 PM with paraesthesiae, leg pain, a petechial rash on the face, and a subfebrile temperature (37,5 °C) that had been present since the previous day. On admission, purpura was noted on the head and extremities, raising suspicion of disseminated intravascular coagulation. Due to neurological symptoms, meningococcal sepsis was also considered, despite the absence of meningeal signs. Based on clinical findings of tachycardia and hypertension, along with elevated D-dimer levels (> 35.00 mg/L), pulmonary embolism was suspected but later ruled out by MSCT pulmonary angiography. Hypoxemia and tachycardia raised suspicion of pneumonia, which was ruled out as well.

Laboratory results received at 2:20 PM showed leukopenia (2.89 × 10⁹/L), thrombocytopenia (14 × 10⁹/L), prolonged prothrombin time and elevated C-reactive protein (161.3 mg/L). Empirical antimicrobial therapy with meropenem, vancomycin, and ceftriaxone was initiated immediately. Procalcitonin levels at 3:00 PM were 40.30 µg/L and increased to 55.65 µg/L by 7:00 PM, indicating sepsis with multiorgan failure. Echocardiography revealed severe impairment of myocardial systolic function with global hypokinesia. The patient died at 8:00 PM. Autopsy revealed a rudimentary spleen, and microbiological analysis of blood cultures performed the following day confirmed the causative pathogen as Streptococcus pneumoniae.

CONCLUSION

The rapid onset of fulminant sepsis with multiorgan failure and a fatal outcome in a patient with an unrecognized rudimentary spleen points out the importance of identifying splenic anomalies and the immediate initiation of antimicrobial therapy, particularly in asplenic patients.