Q: 52 year old male is admitted with severe sepsis two days after dog bite. After admission, lab called to inform you that patient's blood smear showed Howell-Jolly bodies. What part of the history should be evaluated again?


Answer: Previous splenic injury

Unusual as well as rapid deterioration with sepsis should bring forward the question of hyposplenism. In Dog bites, rapid sepsis often due to capnocytophaga canimorsus (gram negative rods) should raise the probability of previous splenic pathology. Blood smears usually demonstrate Howell-Jolly bodies in the erythrocytes of asplenic and in patients with functional hyposplenism.