Hyposplenism as a cause of pneumococcal meningoencephalitis in an adult patient with coeliac disease

  • Paolo Caraceni | umberto.volta@aosp.bo.it
  • Barbara Benazzi
  • Giacono Caio
  • Giacomo Zaccherini
  • Marco Domenicali
  • Umberto Volta

Abstract

Introduction: Coeliac disease can be associated with hyposplenism and splenic atrophy, which may increase the patient’s risk for fatal infections caused by Streptococcus pneumoniae or Pneumococcus. It is general opinion that many more patients with coeliac disease have died from hyposplenism-related infections than those reported in literature.
Case report: A 62-year-old woman with recently diagnosed coeliac disease was hospitalized with high fever, disorientation, and nuchal rigidity. Cerebral computed tomography was negative. Laboratory tests showed an elevated leukocyte count and very high levels of C reactive protein. The cerebrospinal fluid (CSF) contained an increased number of mononuclear cells associated with a low glucose level and high protein concentrations. The CSF culture was positive for Streptococcus pneumoniae. Neurological conditions rapidly deteriorated with the onset of coma, and magnetic resonance imaging of the brain revealed initial signs of encephalitis extending above and below the tentorium. Abdominal ultrasonography disclosed splenic hypotrophy that raised the suspicion of hyposplenism. The diagnosis of hyposplenism was confirmed by demonstration of Howell-Jolly bodies in a peripheral blood smear.
Discussion: This is the first reported case of pneumococcal meningoencephalitis caused by splenic hypofunction in a patient with coeliac disease. When coeliac disease is diagnosed with a marked delay in an elderly patient, spleen function should always be assessed. If impaired, the patient should undergo vaccination with pneumococcal conjugate vaccine to prevent pneumococcal infections.

Downloads

Download data is not yet available.
Published
2013-03-07
Section
Case Reports
Keywords:
Coeliac disease, Hyposplenism, Streptococcus pneumoniae meningoencephalitis.
Statistics
Abstract views: 462

PDF: 436
Share it

PlumX Metrics

PlumX Metrics provide insights into the ways people interact with individual pieces of research output (articles, conference proceedings, book chapters, and many more) in the online environment. Examples include, when research is mentioned in the news or is tweeted about. Collectively known as PlumX Metrics, these metrics are divided into five categories to help make sense of the huge amounts of data involved and to enable analysis by comparing like with like.

How to Cite
Caraceni, P., Benazzi, B., Caio, G., Zaccherini, G., Domenicali, M., & Volta, U. (2013). Hyposplenism as a cause of pneumococcal meningoencephalitis in an adult patient with coeliac disease. Italian Journal of Medicine, 5(2), 124-127. https://doi.org/10.4081/itjm.2011.124