Year: 2009
Type: article
Study design: Case Report
Abstract: A 72-year-old male diabetic patient was admitted due to autoimmune hemolytic anemia (AIHA). We started 1mg/kg weight of prednisolone daily and multiple daily insulin infusion for hyperglycemia. Gall bladder cancer and early stage gastric cancer were then diagnosed. We removed the gall bladder and the spleen for treatment of AIHA without prednisolone for better control of diabetes mellitus. Five weeks later, endoscopic gastromucosal resection (EMR) was performed for gastric cancer. The patient suffered from fever and respiratory failure after 4 days. Chest computed tomography showed consolidation, bronchial wall thickening and a ground glass appearance in bilateral lungs. Although the sputum and blood culture were negative, β-D-glucan and mannan antigen increased. Neutrophilia (87%) was shown. The WBC count had not increased (7300/μl) compared with the CRP elevation (21.8mg/dl). Therefore, we diagnosed overwhelming postsplenectomy infection syndrome followed by atypical pathogen infection. We used ciprofloxacin and fosfluconazol, respirator at low tidal volume ventilation, sivelestat sodium hydrate and methylprednisolone for respiratory failure and regular insulin aiming for a blood glucose range of from 80 to 140mg/dl. The patient subsequently recovered.
Source: The Kitakanto Medical Journal
DOI: 10.2974/kmj.59.275
Authors: Mai Tomizawa, Takashi Nagai, Kazunori Tonouchi, Naoko Tonooka, Gen Takahashi, Mie Kotake, Ken Masubuchi, Takao Ishizuka, Kunihiko Iizuka, Yoshio Umegae
Institution: Public Tomioka General Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W946351791