A patient with multiple myeloma and a normal spleen died with high-grade pneumococcal bacteremia diagnosed by routine examination of a Wright-stained peripheral blood smear. In earlier reports, this finding has been described only in patients with abnormal or absent spleens. We review the proposed mechanisms of high-grade pneumococcal bacteremia in these patients and the immunologic abnormalities in patients with multiple myeloma that may result in increased susceptibility to this infection.
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Marshall R. Posner (1978) studied this question.