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Pneumococcal Bacteremia and Disseminated Intravascular Coagulation

Alan L. Bisno, MD
Arch Intern Med. 1970;126(3):526. doi:10.1001/archinte.1970.00310090156025.
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To the Editor.  —The interesting case report by Stossel and Levy (Arch Intern Med125:876-878,1970) of a patient with pneumococcal bacteremia and disseminated intravascular coagulation (DIC) represents another example of a syndrome which is being recognized with increasing frequency: the triad of hyposplenism, pneumococcal sepsis, and DIC. There is increasing clinical evidence that pneumococcemia rarely, if ever, initiates DIC in a patient with a normally functioning spleen. Since the recent reviews of this subject by Whitaker1 and ourselves,2 additional cases have been reported in two children with hemoglobinopathy3 and in a splenectomized adult patient.4In the past most reports of overwhelming infection after splenectomy have been in children, and some authors have attributed the increased risk of infection to serious underlying diseases.5 The patient reported by Stossel and Levy illustrates well two striking features associated with this syndrome: the frequency with which adults are affected and the frequency with


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