Pneumococcal septic arthritis after splenectomy in Felty's syndrome

Felty's syndrome is characterized by three features: rheumatoid arthritis, splenomegaly (enlarged spleen), and decreased levels of platelets (cells important in blood clotting) or decreased numbers of neutrophils (white blood cells important in inflammation). This triad of conditions is present in one percent of patients with rheumatoid arthritis. Low levels of platelets and other complications can require splenectomy (removal of spleen), placing these patients at risk for severe sepsis (systemic infection). A case is described of a 32-year-old woman with Felty's syndrome who developed pneumococcal septic arthritis following splenectomy. Pneumococcal infections are caused by a group of 85 or more types of bacteria, and can result in pneumonia or other serious infections. Recovery occurs as the immune system develops antibodies against the specific type of infecting bacteria. The risk for developing severe pneumococcal sepsis after splenectomy is high among patients with Felty's syndrome. Most individuals, including this patient, are given pneumococcal vaccine prior to surgery to promote the formation of antibodies against the major types of pneumococcal bacteria. It is possible that this woman, like some other patients with rheumatoid arthritis, responded ineffectively to immunization. She developed septic arthritis of the knees and an unusual complication that was diagnosed as pneumococcal-associated kidney disease. She was treated with penicillin for six months, and arthritis and kidney function gradually improved. Blood tests showed that the patient had produced antibodies against only 2 of the 23 types of pneumococci molecules in the vaccine, but had vigorously responded to the infecting bacteria. The case indicates the potential risk of pneumococcal infection among patients with Felty's syndrome who undergo splenectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)