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Splenectomy, Immunosuppressive Therapy, and Sepsis

William Spickler, MD, PhD; Paul K. Hamilton, MD; Richard E. Holman, MD
JAMA. 1978;239(4):295. doi:10.1001/jama.1978.03280310027009.
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To the Editor. —  In the article "Acute Bacteremia in Asplenic Renal Transplant Patients" (237:2207, 1977), Schröter et al suggest that the occurrence of fulminant sepsis in transplant patients may be related more to prior splenectomy than to the immunosuppressive therapy required by these patients. Weitzman and Aisenberg1 recently described three cases of fulminant sepsis in patients with prior splenectomy and immunosuppressive therapy in the form of total nodal irradiation and chemotherapy for Hodgkin's disease. We wish to report a recent case, suggesting also that the combination of splenectomy and immunosuppression is far more hazardous than splenectomy alone.

Report of a Case.—  Our patient was a 41-year-old man who seven years previously underwent prior splenectomy, total nodal irradiation, and chemotherapy with a regimen of cyclophosphamide, vincristine sulfate (Oncovin), prednisone, and procarbazine hydrochloride (COPP). He had been given no medications for the two months prior to his admission.In December


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