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.

Paolo Caraceni, Barbara Benazzi, Giacomo Caio, Giacomo Zaccherini, Marco Domenicali, Umberto Volta (2011). Hyposplenism as a cause of pneumococcal meningoencephalitis in an adult patient with coeliac disease. ITALIAN JOURNAL OF MEDICINE, 5, 124-127 [10.1016/j.itjm.2011.02.005].

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

CARACENI, PAOLO;BENAZZI, BARBARA;CAIO, GIACOMO PIETRO ISMAELE;ZACCHERINI, GIACOMO;DOMENICALI, MARCO;VOLTA, UMBERTO
2011

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.
2011
Paolo Caraceni, Barbara Benazzi, Giacomo Caio, Giacomo Zaccherini, Marco Domenicali, Umberto Volta (2011). Hyposplenism as a cause of pneumococcal meningoencephalitis in an adult patient with coeliac disease. ITALIAN JOURNAL OF MEDICINE, 5, 124-127 [10.1016/j.itjm.2011.02.005].
Paolo Caraceni;Barbara Benazzi;Giacomo Caio;Giacomo Zaccherini;Marco Domenicali;Umberto Volta
File in questo prodotto:
Eventuali allegati, non sono esposti

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/325123
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 2
  • ???jsp.display-item.citation.isi??? ND
social impact