A splenectomized three-year-old developed fulminant pneumococcal septicemia despite immunization and chemoprophylaxis. The course was rapidly fatal. Fulminant pneumococcal septicemia mainly affects splenectomized individuals and is associated with very substantial mortality. Immunization prior to splenectomy and daily prophylactic oral penicillin have partial preventive efficacy. Other useful measures include carrying a health status card and inpatient antimicrobial therapy in the event of fever. The need for these precautions should be repeatedly discussed with the child's parents and physician.