An Overwhelming Postsplenectomy Infection Syndrome Associated with Diabetes M ellitus

A 72-year-old male diabetic patient was admitted due to autoimmune hemolytic anemia (AIHA).\nWe started 1mg/kg weight of prednisolone daily and multiple daily insulin infusion for hyperglycemia.\nGall bladder cancer and early stage gastric cancer were then diagnosed. We removed the gall bladder\nand the spleen for treatment of AIHA without prednisolone for better control of diabetes mellitus. Five\nweeks later, endoscopic gastromucosal resection (EMR) was performed for gastric cancer. The patient\nsuffered from fever and respiratory failure after 4 days. Chest computed tomography showed consolidation,\nbronchial wall thickening and a ground glass appearance in bilateral lungs. Although the sputum\nand blood culture were negative,β-D-glucan and mannan antigen increased. Neutrophilia (87％)was\nshown. The WBC count had not increased (7300/μl) compared with the CRP elevation (21.8mg/dl).\nTherefore, we diagnosed overwhelming postsplenectomy infection syndrome followed by atypical pathogen\ninfection. We used ciprofloxacin and fosfluconazol, respirator at low tidal volume ventilation,\nsivelestat sodium hydrate and methylprednisolone for respiratory failure and regular insulin aiming for\na blood glucose range of from 80 to 140mg/dl. The patient subsequently recovered