A non-resolving splenic ‘abscess’ in an elderly male – An unusual manifestation of splenic lymphoma

Abstract

Splenic abscess is a relatively uncommon condition, posing a diagnostic and therapeutic challenge for the treating physician. It occurs due to haematogenous spread from endocarditis or other septic foci, especially in immune-compromised individuals and diabetics. We describe an elderly male who presented with splenomegaly and low-grade fever with no predisposing factors. Examination revealed a tender splenomegaly. Ultrasonography (US) showed a hypoechoic area within the spleen from which guided aspiration of pus grew Staphylococcus aureus and Klebsiella pneumoniae. Percutaneous drainage and culture-based antibiotics failed to resolve the abscess, obligating surgical drainage. Intraoperative biopsy from the abscess wall was reported as splenic marginal lymphoma. This unusual presentation of lymphoma needs to be considered in splenic abscess without known risk factors.

Primary splenic diffuse large B‐cell lymphoma presenting as a splenic abscess

“…Of particular interest is the presentation of this splenic lymphoma as a continuously‐draining abscess. In the literature review, we identified four reports of splenic lymphoma presenting as an abscess: marginal zone lymphoma [ 12 ], DLBCL [ 13 , 14 ], and Hodgkin lymphoma. [ 15 ] Most similar to our patient was the case of the marginal zone lymphoma; percutaneous drainage, in that case, yielded purulent material that grew Staphylococcus aureus and Klebsiella pneumoniae , but the patient failed to significantly improve with antibiotics.…”