Aseptic Splenic Abscess as Precursory Extraintestinal Manifestation of Inflammatory Bowel Disease

Abstract

Splenic abscesses are most often secondary to aerobic bacterial infections due to Streptococcus, Staphylococcus, and Enterococcus species of organisms. Sterile splenic abscesses rarely occur and diagnosis and treatment of those are challenging. We report a case of a previously healthy young female presenting with aseptic splenic abscesses as the initial manifestation of Crohn's disease along with a review of the literature on aseptic splenic abscess as an extraintestinal manifestation of Crohn's disease.

Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature

“…Maintenance therapy should follow because relapse is common, as seen in over half of the patients in the literature review and in one of our two patients. Interestingly, no patients in the literature experienced relapse while on maintenance therapy of azathioprine, sulfasalazine, adalimumab, or infliximab, although the durability of this response is unknown [ 7 , 8 , 10 , 13 , 17 , 19 , 21 ]. There were no reported fatal outcomes.…”

Aseptic Abscess Syndrome with Severe Skin Involvement: Case Report

“…One case reported from France had necrotic cutaneous abscesses in the distal extremities, which is clinically similar to our case, and the patient developed Crohn's disease 6 months later. [ 4 ] In our case, ileocolonoscopy was performed with a biopsy, and no inflammatory bowel disease was found. The literature includes cases that developed inflammatory intestinal disease after 3–4 years.…”

“…Aseptic abscess syndrome is a disorder included in the group of neutrophilic diseases. [ 1 4 5 ] The diagnosis is established by excluding other diseases in a differential diagnosis. [ 3 ] Our case had a liver abscess for 4 years, and his general condition rapidly deteriorated when he also developed an abscess in the spleen, and then he developed cutaneous abscesses.…”

“…[ 2 4 5 ] The literature reports that visceral abscesses are accompanied by pyoderma gangrenosum, Sweet's syndrome, and leukocytoclastic vasculitis. [ 1 2 3 4 5 ] Most of the reported cases of aseptic abscess syndrome are from continental Europe, with France in the lead with a series of 30 cases. It is believed that the reason for this limited number of reports is that the disease is not well-known, not that it is rare.…”

A challenging case of multiple splenic and pancreatic lesions in a patient with Crohn's disease

“…MASA syndrome is a systemic disorder of unknown aetiology involving polymorphonuclear neutrophils 3. MASA syndrome is either associated with another disease, mainly Crohn's disease4 of which it may precede its diagnosis5 6 or polychondritis or is idiopathic. Antibiotics fail to achieve cure but there is a marked and fast improvement with corticosteroids.…”