{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:19:42Z","timestamp":1777670382028,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["P30 CA016672"],"award-info":[{"award-number":["P30 CA016672"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>A patient in his 40s with splenic angiosarcoma metastatic to the liver underwent splenectomy, chemotherapy, and partial hepatectomy before being treated on a clinical trial with CTLA4 and PD1 inhibitors. He had received pneumococcal and meningococcal vaccines post-splenectomy. On week 10, he developed grade 3 immune-related colitis, successfully treated with the anti-tumor necrosis factor-alpha inhibitor infliximab and steroids. After 4 cycles of treatment, scans showed partial response. He resumed anti-PD1 therapy, and 6 hours after the second dose of anti-PD1 he presented to the emergency room with hematemesis, hematochezia, hypotension, fever, and oxygen desaturation. Laboratory tests demonstrated acute renal failure and septicemia (<jats:italic>Streptococcus pneumoniae<\/jats:italic>). He died 12 hours after the anti-PD1 infusion from overwhelming post-splenectomy infection (OPSI). Autopsy demonstrated non-viable liver tumors among other findings. In conclusion, patients undergoing immunotherapy and with prior history of asplenia should be monitored closely for OPSI as they may be at increased risk.<\/jats:p>","DOI":"10.3389\/fimmu.2024.1366271","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T04:38:07Z","timestamp":1715143087000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Case report: Fatal overwhelming post-splenectomy infection in a patient with metastatic angiosarcoma treated with immunotherapy"],"prefix":"10.3389","volume":"15","author":[{"given":"Carlos","family":"Torrado","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet A.","family":"Baysal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhijit","family":"Chakraborty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Becky L.","family":"Norris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fareed","family":"Khawaja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apostolia M.","family":"Tsimberidou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1146\/annurev.me.37.020186.000405","article-title":"The role of the spleen in resistance to infection","volume":"37","author":"Bohnsack","year":"1986","journal-title":"Annu Rev Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.6898","article-title":"Post-splenectomy sepsis: A review of the literature","volume":"12","author":"Tahir","year":"2020","journal-title":"Cureus"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-195208000-00006","article-title":"Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy","volume":"136","author":"King","year":"1952","journal-title":"Ann Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/PL00012341","article-title":"Tribute to a triad: history of splenic anatomy, physiology, and surgery-part 2","volume":"23","author":"McClusky","year":"1999","journal-title":"World J Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s100240010145","article-title":"Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited","volume":"4","author":"Hansen","year":"2001","journal-title":"Pediatr Dev Pathol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.092460","article-title":"Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up","volume":"99","author":"Kristinsson","year":"2014","journal-title":"Haematologica"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2147\/IDR","article-title":"Post-splenectomy sepsis: preventative strategies, challenges, and solutions","volume":"12","author":"Luu","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.18262","article-title":"Sustained complete response of metastatic cutaneous squamous cell carcinoma by immune checkpoint inhibition in a renal transplant patient: a case report","volume":"36","author":"Su","year":"2022","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2019.10.022","article-title":"Necrotizing soft tissue invasive aspergillosis in a cancer patient treated with immunosupressants due to checkpoint inhibitor-induced hepatitis","volume":"80","author":"Malek","year":"2020","journal-title":"J Infect"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.54.3.214","article-title":"Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed","volume":"54","author":"Waghorn","year":"2001","journal-title":"J Clin Pathol"},{"key":"B11","article-title":"Overwhelming postsplenectomy infection still a problem","volume":"157","author":"Brigden","year":"1992","journal-title":"West J Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08843.x","article-title":"Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force","volume":"155","author":"Davies","year":"2011","journal-title":"Br J Haematol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)42339-X","article-title":"Postsplenectomy infection","volume":"61","author":"Francke","year":"1981","journal-title":"Surg Clin North Am"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199906103402308","article-title":"Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1999. A 42-year-old asplenic man with gram-negative sepsis","volume":"340","author":"Parsonnet","year":"1999","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit669","article-title":"Bordetella holmesii bacteremia cases in the United States, April 2010-January 2011","volume":"58","author":"Tartof","year":"2014","journal-title":"Clin Infect Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1097\/00005373-198611000-00007","article-title":"Late septic complications in adults following splenectomy for trauma: a prospective analysis in 144 patients","volume":"26","author":"Green","year":"1986","journal-title":"J Trauma"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.4393","article-title":"Infectious complications of immune checkpoint inhibitors in solid organ Malignancies","volume":"11","author":"Ross","year":"2022","journal-title":"Cancer Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s11523-021-00824-3","article-title":"Risk of infection with immune checkpoint inhibitors: A systematic review and meta-analysis","volume":"16","author":"Petrelli","year":"2021","journal-title":"Target Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2006.08.010","article-title":"Infection and musculoskeletal conditions: Bacterial and opportunistic infections during anti-TNF therapy","volume":"20","author":"Strangfeld","year":"2006","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-008-0062-1","article-title":"Tumor necrosis factor inhibitors and infection complications","volume":"10","author":"Crawford","year":"2008","journal-title":"Curr Rheumatol Rep"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.19.2275","article-title":"Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and Malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials","volume":"295","author":"Bongartz","year":"2006","journal-title":"JAMA"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13348","article-title":"Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand","volume":"47","author":"Kanhutu","year":"2017","journal-title":"Intern Med J"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy141","article-title":"A registry for patients with asplenia\/hyposplenism reduces the risk of infections with encapsulated organisms","volume":"67","author":"Arnott","year":"2018","journal-title":"Clin Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(97)93232-1","article-title":"A study of 42 episodes of overwhelming post-splenectomy infection: is current guidance for asplenic individuals being followed","volume":"35","author":"Waghorn","year":"1997","journal-title":"J Infect"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2017.01.006","article-title":"Adherence to vaccination guidelines post splenectomy: A five year follow up study","volume":"10","author":"Boam","year":"2017","journal-title":"J Infect Public Health"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.11.005","article-title":"Overwhelming post splenectomy infection syndrome - review study","volume":"12","author":"Sinwar","year":"2014","journal-title":"Int J Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/14760584.2021.1886085","article-title":"Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis","volume":"20","author":"Bianchi","year":"2021","journal-title":"Expert Rev Vaccines"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.2018.72.issue-5","article-title":"The effect of splenectomy on the levels of PCV-13-induced memory B- and T cells","volume":"72","author":"Gazi","year":"2018","journal-title":"Int J Clin Pract"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-023-00775-7","article-title":"Features and long-term outcomes of stage IV melanoma patients achieving complete response under anti-PD-1-based immunotherapy","volume":"24","author":"Chatziioannou","year":"2023","journal-title":"Am J Clin Dermatol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"793","DOI":"10.3390\/cancers15030793","article-title":"Complete response in metastatic clear cell renal cell carcinoma patients treated with immune-checkpoint inhibitors: remission or healing? How to improve patients' Outcomes","volume":"15","author":"Thouvenin","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34636","article-title":"Complete pathological response after chemotherapy or immune checkpoint inhibitors in deficient MMR metastatic colorectal cancer: Results of a retrospective multicenter study","volume":"153","author":"Marolleau","year":"2023","journal-title":"Int J Cancer"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1200\/PO.20.00103","article-title":"Spontaneous regression and complete response to immune checkpoint blockade in a case of high-grade neuroendocrine carcinoma","volume":"4","author":"Raufi","year":"2020","journal-title":"JCO Precis Oncol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1158\/2326-6066.CIR-13-0193","article-title":"Sustained complete response to CTLA-4 blockade in a patient with metastatic, castration-resistant prostate cancer","volume":"2","author":"Graff","year":"2014","journal-title":"Cancer Immunol Res"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1366271\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T04:38:10Z","timestamp":1715143090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1366271\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,8]]},"references-count":33,"alternative-id":["10.3389\/fimmu.2024.1366271"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2024.1366271","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,8]]},"article-number":"1366271"}}