Abstract

Pneumococcal infections are the most frequent vaccine preventable cause of death in Germany next to influenza. Asplenic patients in particular should be vaccinated to avoid serious illness and even death, as the following case reported in Germany’s surveillance bulletin shows (1). A 37 year old woman who had had a splenectomy after a road traffic accident in 1990, and had recently been treated with mirtazapine as a hospital inpatient for postpartum depression, developed a feverish infection with shivers, dizziness, and vomiting three weeks after being discharged. The patient herself suspected food poisoning but no food samples were available for testing. She deteriorated and developed petechiae, and the next day the emergency doctor admitted her to intensive care. She developed Waterhouse-Friderichsen syndrome with disseminated intravascular coagulation (DIC) and died in the evening of the same day from septic toxic shock. No meningococci or botulinum toxin were found but Streptococcus pneumoniae was isolated from a blood specimen.