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July 1992

Autosplenectomy Complicating Pneumococcal Meningitis in Adults

Author Affiliations

Huntington, WVa

Arch Intern Med. 1992;152(7):1532-1533. doi:10.1001/archinte.1992.00400190148036

To the Editor. —  I read with interest the article by Eshel and colleagues1 about autosplenectomy that developed late in the course of pneumococcal meningitis, and a few questions crossed my mind.First, in their article, the authors related what seems to be acute splenic infarctions and subsequent autosplenectomy to thrombocytosis (with the thrombocyte count of 720 × 109/L and the raised serum fibrinogen level at 6.2 g/L). It is likely that the patient was predisposed to pneumococcal meningitis through underlying hyposplenism, although the authors did not think that their patient had it before—by virtue of the normal platelet count and fibrinogen concentration at the time of admission— but, again, both of these abnormalities could have been acutephase reactants, and thrombocytosis was the result, rather than the cause, of hyposplenism secondary to other etiologic factors—especially as the platelet count was moderately elevated.Second, in their article, the