A 12-year-old boy presented with fever and left-sided upper abdominal pain

Abstract

A 12-year-old boy of nonconsanguineous parents presented with the history of fever and left sided upper abdominal pain for 1 month. His fever was high grade, intermittent, associated with chills and rigor. The abdominal pain was dull aching in nature without any radiation, aggravating or relieving factors. His bowel habit was normal. The child had no history of jaundice, cough, respiratory distress, burning sensation during micturition, earache, skin infection, contact with tubercular patient, blood transfusion or parenteral medication.On examination, she was fretful, febrile, moderately pale, and anicteric. Tachycardia was present. Per abdominal examination revealed tenderness at the left hypochondriac region. There were splenomegaly (4 cm) and nontender hepatomegaly (just palpable). Ascites was absent. Other systemic examinations were normal.The complete blood count showed moderate anemia, neutrophilic leukocytosis and thrombocytosis (Table I). The erythrocyte sedimentation rate was high. Urine routine microscopy and widal test, serum alanine amino transferase were normal. Immunochromatography for kala -azar, immunochromatography for malaria and serology for dengue virus were negative. Blood and urine culture showed no growth of the organism. Montoux test was positive and the X -ray chest and abdomen were normal.The ultrasonography of the abdomen showed spleen was enlarged, size-12.8 cm, multiple small hypoechoic lesion in splenic parenchyma, large one 8.2 x 0.6 mm, suggestive of multiple splenic abscess (Figure 1).Based on history, examination findings and investigations, the diagnosis was splenic abscess. As other common causes of fever and upper abdominal pain were excluded (urinary tract infection, malaria, kala-azar, dengue) and the ultrasonography of the abdomen was suggested as splenic abscess.