Mar 28, 20 pyoderma gangrenosum pg is a painful, ulcerating neutrophilic dermatosis commonly associated with a variety of underlying systemic conditions. Etiology, clinical spectrum and therapy 38 patients, recent series have showed greater numbers of fungal isolates, including candida albicans, aspergillusspp, and agents of mucromycosis. Pyoderma gangrenosum associated with an aseptic splenic. He postulated that 1 of 3 courses was followed by a patient with a splenic abscess.
Fungal splenic abscesses respond much more favorably to antifungal therapy. Splenic abscess is an uncommon disease, with a reported incidence of 0. Splenic infarct not requiring any treatment occurred in 21% of patients, and 3% later developed a splenic abscess. The surgeon can explore and manage coexisting septic collections. In the presented case, the cause of splenic abscess was not identified since the patient had no history that fit into one of the five categories above. Lactobacillus acidophilus induced endocarditis and. Case report splenic abscess as a potential initial manifestation of quiescent infective endocarditis in a patient with bronchopneumonia lindsay mcowat, kah fai wong, george i varughese, ananth u nayak. Splenic abscess complicating infectious endocarditis. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the radionuclide 99m technetium which shows abscess as a negative or filling defect. B pseudomallei is a potential causative organism of splenic abscess in patients with risk factors who reside in endemic areas and do not respond to standard antibiotics. Management of an embolic splenic abscess usually involves surgical splenectomy or imageguided drainage, but the natural history of splenic abscess without drainage is unknown. Nov 11, 2015 splenic abcess is an uncommon complication for cancer treatment. Conservative management of splenic abscess septic emboli after.
Splenic abscess in cancer chemotherapy bmc research. Splenic abscess as a potential initial manifestation of. It is commonly known as nonpathogen in the human body. Received 6 june 2015 and revised version accepted 24 august 2015. Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. There are also some reports of spontaneous splenic abscess, causing acute abdominal pain.
Case report splenic abscess as a potential initial. Splenic abscess complicating infectious endocarditis jama. We report a case of splenic abscess, caused by salmonella typhi, and coinfection with leptospira in a previously healthy young male. The history and physical examination are not sufficiently reliable to make the diagnosis of splenic abscess. In an 18month period candidal splenic abscesses were diagnosed and treated in eight patients. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. Splenic abscess is a rare clinical finding, with a reported prevalence between 0. Especially when there is a splenic defect on an abdominal computed tomography in patients who are refractory to antibiotic therapy, total. This paper aims to provide an update on the treatments and dilemmas of nonoperative management of splenic injuries in adults and to offer suggestions that may improve both consensus and patient outcomes. Splenic infarction and abscess in the setting of infective endocarditis. Etiology, clinical spectrum and therapy 39 the only laboratory abnormality that is frequently present is leukocytosis, which is seen in 60% to 80% of cases 2.
The journal of the association of physicians of india. If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then splenectomy can be performed. Splenic rupture knowledge for medical students and. Case series article pdf available in journal of the saudi heart association 983 february 2015 with 39 reads how we measure reads. Splenic abscesses, like abscesses elsewhere, are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. It occurs more frequently in immunocompromised patients. We report a case of splenic abscess associated with infective endocarditis with evidence of sepsis, vegetation, and positive blood cultures. She was treated at that time with thalidomide 100 mgd and oral prednisone 20 mgd physical examination was unremarkable. They uncommonly affect the spleen due to its efficient reticuloendothelial system phagocytic activity and, consequently, are more likely seen in immunosuppressed patients. Splenic abscess is a rare clinical entity, occurring in 0. Splenic abscess is an uncommon condition with a high mortality rate due to delayed detection and treatment. Splenic abscess presentation, diagnosis, and treatment. The management of multiple splenic abscesses after sg could be conservative in highly selected cases. The largest series of splenic abscesses reported in the literature is that of chang et al.
However, the optimal treatment for this remains unclear. The decision of adopting such conservative management should be based on the clinical condition of. Her past medical history was significant for a colonic and perianal crohns disease refractory to medical. The incidence of splenic abscesses has been estimated to be between 0. The patients had a clinical profile of nontoxic appearance with a. Isolated tubercular splenic abscess in an immunocompetent individual is rarely reported. An update on nonoperative management of the spleen in. Nov, 2015 the exclusion of splenic tuberculosis is necessary as a differential diagnosis of fever of unknown origin, especially in areas in which the disease is endemic. Splenic abscess due to acute brucellosis is a rare event. The patient was treated with percutaneous drainage and antibiotics. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. Splenic abscess in cancer chemotherapy springerlink. Necrobiosis lipoidica is an idiopathic dermatosis of unknown origin, occurring mainly in patients with diabetes. These complications included three splenic abscesses, two symptomatic splenic infarcts, and three coil migrations in 2 patients who.
Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one third of the cases. Splenic abscesses are a rare but potentially lifethreatening complication of nontyphoidal salmonella bacteraemia splenic abscesses should be considered as a possible source of infection in patients presenting with unexplained fevers and. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as on the size and topography of the abscess. Splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. Splenic abscess, salmonella paratyphi a introduction. Sleeve gastrectomy sg is a surgical weightloss procedure. Rapid diagnosis and treatment are essential as its course can be fatal. Splenic abscess is an uncommon lesion with high mortality rates because of delayed detection and treatment 1,2,3,4. Diagnosis and treatment of splenic fungal abscesses in the. The mri revealed sharply demarcated lesions measuring 20 and 30 mm in diameter at the superior pole of spleen. Untreated splenic abscess has a high mortality rate. In this context, this article reports a case of splenic abscess diagnosed in a.
Typhoid splenic abscess sri lankan journal of infectious diseases. The patient had serial ttes during the treatment course. Splenic abscess is an uncommon entity that can be treated percutaneously. Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction tissue death due to oxygen shortage in the organ. It is particularly uncommon in healthy young adults 16. A case of splenic abscess complicated by infective. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. Splenic abscess caused by streptococcus gallolyticus subsp.
Nonsurgical management of multiple splenic abscesses in an. Splenic abscesses are a frequent finding in bacterial endocarditis and are present in up. Apr 21, 2020 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. May 25, 2007 it has been shown that splenic abscesses respond poorly to antibiotics alone. Lactobacillus acidophilus is a rodshaped, grampositive bacterium generally found in the normal flora of the oropharynx, gastrointestinal, and genitourinary tracts. The exclusion of splenic tuberculosis is necessary as a differential diagnosis of fever of unknown origin, especially in areas in which the disease is endemic. There are also some reports of spontaneous splenic abscess, causing acute abdominal pain and clinical hypersplenism with bleeding tendencies. Splenic abscess should be included in the differential diagnosis of pneumoperitoneum, particularly in the clinical setting of an immunocompromised state. A splenic abscess causing pneumoperitoneum is even rarer in that only six such cases have been reported to date.
Feb 14, 2015 splenic abscess is a welldescribed but rare complication of infective endocarditis. Many patients with blunt splenic injury are considered for nonoperative management and, with proper selection, the success rate is high. However, the authors do not discard a possible trauma not seen by the owner. In rare cases, it may also be caused by spontaneous rupture from an infection or a hematological condition. In the last 30 years at the johns hopkins hospital, only 11 patients have been treated for clinically overt splenic abscess. The cases reported in veterinary medicine suggest trauma as the main cause of abscess formation in this organ. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, longterm use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with candida.
The common signs and symptoms described of a splenic abscess include the triad of fever, left upper quadrant tenderness, and leukocytosis is present only in onethird of the cases. Splenic abscess is a rare entity that remains mainly a subject of case reports. Ctguided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen. Feb 25, 2015 laparoscopic splenectomy for splenic abscess. Splenic abscess is a rare but welldocumented complication of infective endocarditis. The mortality rate is as high as 50% when antimicrobial therapy is the only treatment used for a pyogenic splenic abscess.
Splenic abscess is a rare complication of enteric fever due to salmonella paratyphi a. Splenic tuberculosis in an immunocompetent patient can be. Abscesses of the spleen have been reported periodically since the time of. Apr 21, 2020 splenic abscess is a rare entity, with a reported frequency of 0.
Splenic abscess due to salmonella schwarzengrund in a previously healthy individual returning from bali. The classic triad fever, pain of the left hypochondrium, and sensitive mass left is only. Treatment of a splenic abscess varies according to the response to antibiotics. Most splenic abscesses are due to aerobial microorganisms. Splenic abscess due to salmonella schwarzengrund in a. Pillai department of clinical veterinary medicine, college of veterinary and. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as the size and topography of the abscess. Splenic abscess is also an uncommon infection that classically.
A ruptured spleen may result in massive intraabdominal bleeding and should therefore be treated as a medical emergency. Splenic abscess is an extremely rare complication of sg. Splenectomy and valve replacement in patients with infective. Due to the lack of information about the subject, the aim of this paper is to report the case and treatment of a splenic abscess in a dog. Mandell, douglas, and bennetts principles and practice of infectious diseases eighth edition, 2015. However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the. A 35yearold woman with severe crohns disease presented for evaluation of a persistent continuous lowgrade fever and asthenia for few days. Here we present a case of a young, immunocompetent male with isolated splenic cold abscesses, who was diagnosed with splenic tuberculosis and managed successfully with percutaneous drainage and antitubercular therapy alone. Principles and practice of infectious diseases eighth edition, 2015. Sep 03, 2017 splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. The classic triad fever, pain of the left hypochondrium, and sensitive mass left is only present in onethird of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss. Plasmodium vivax infection manifesting as splenic abscess.
Splenic abscess in cancer chemotherapy bmc research notes. Splenic abscess and multiple brain abscesses caused by. Endocarditis due to lactobacillus is rarely encountered and associated with impaired immunity. In most of these patients, hemoglobinopathies or some other underlying immunocompromised state is usually present. Splenic abscess associated with endocarditis in a patient.
Splenic abscess is a rare entity, with a reported frequency of 0. Streptococci accounted for 18 abscesses, with six containing enterococci. Splenic abcess is an uncommon complication for cancer treatment. Splenomegaly in children see approach to the child with an enlarged spleen. Splenic abscess represent either a local or multifocal lesion. Fever is the most common symptom of splenic abscess, followed by abdominal pain and a tender mass on palpation of the left upper quadrant of the abdomen. From 2010 to 2015, 60 patients were treated at our department for ie. Injury to the spleen is most often the result of blunt abdominal trauma. Pyoderma gangrenosum pg is a painful, ulcerating neutrophilic dermatosis commonly associated with a variety of underlying systemic conditions. Four cases of splenic abscess after sg have been reported, all managed by surgical intervention. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults.
Splenectomy is required in most cases and laparoscopic surgery. Splenic abscess associated with infective endocarditis. Splenectomy has long been considered the standard treatment of splenic abscess. Right axial cect in a patient with a recent history of traumatic injury to the spleen and a new fever demonstrates a rimenhancing fluid collection with an airfluid level, consistent with a splenic abscess. Untreated splenic abscesses are fatal, and there is no consensus regarding treatment. Ultrasonography alone may not be beneficial in reaching a diagnosis of splenic abscess as conditions like cyst, nodular hyperplasia, necrosis and hematoma may result in similar ultrasound findings. Peak incidences are between ages 3040 and 6070 years. It generally occurs in patients with neoplasia, immunodeficiency, trauma, metastatic infection, splenic infarct, or diabetes. Successful conservative management of a large splenic. Appropriate antibiotics and adequate surgical drainage can contribute to a. Splenic abscess complicating gastroenteritis due to salmonella virchow in an immunocompetent host splenic abscesses should be suspected in patients with unexplained fevers and left upper quadrant pain lessons from practice clinical record a 20yearold man was admitted to a regional hospital with. We report the first documented case of multiple splenic abscesses following sg managed conservatively by an integrated medical treatment. Spontaneous atraumatic splenic rupture complicating anticoagulant treatment for splenic infarction. Our experience with 3 patients with ie and splenic abscess con.
Oct 29, 2015 published on oct 29, 2015 splenic abscess is a life threatening disease in immunocompromised patients and requires urgent treatment. Splenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. A pus culture from the infection site is the only diagnostic method for visceral abscess melioidosis. We present three case reports that describe the management of splenic abscesses in patients initially diagnosed with infective endocarditis. We report a case of splenic abscess in a young female with uncontrolled diabetes, an incidental finding, who was treated with ct guided drainage and appropriate antibiotics. Splenic abscesses are potentially fatal complication of typhoid fever. Concomitant necrobiosis lipoidica and splenic abscess. Abscesses of the spleen have been reported periodically since the time of hippocrates. Repeat ultrasound a month after splenic drain insertion showed resolving collection. Acr appropriateness criteria american college of radiology. Splenic abscess is a rare clinical entity with an incidence of 0. Madoff, in mandell, douglas, and bennetts principles and practice of infectious diseases eighth edition, 2015. In 2005, haan and colleagues 37 reported complications in the largest singlecenter study of splenic artery embolization for blunt splenic trauma.
Traditional treatment for splenic abscess has been splenectomy and antibiotic therapy but imageguided percutaneous aspiration and drainage can also be considered. Splenic abscesses are uncommon with an incidence at autopsy of 0. Splenic abscesses are a frequent finding in bacterial endocarditis and are present in up to one third of patients at autopsy. Pdf splenic abscess associated with infective endocarditis. It is suggested that a diagnosis of splenic abscess could be reached only based. Splenic abscess is also an uncommon infection that classically results from. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. Splenic abscess complicating gastroenteritis due to. Splenic abscesses are a rare but potentially lifethreatening complication of nontyphoidal salmonella bacteraemia splenic abscesses should be considered as a possible source of infection in patients presenting with unexplained fevers and left upper quadrant or left flank pain. Appropriate management can lower mortality to less than 10%. Depending on the patient population, open splenectomy has a mortality of 017% and a morbidity of 2843%. Splenic abscess is a welldescribed but rare complication of infective endocarditis.