Atraumatic Splenic Rupture: An Unusual Manifestation of Acute HIV Infection

Abstract

A 27-year-old white male, who had sex with other men, presented to the emergency department with 3 days of left shoulder and abdominal pain. He reported no history of trauma to the abdomen. On abdominal imaging, he was found to have hemoperitoneum from a ruptured spleen; he underwent splenectomy. Causes of atraumatic splenic rupture can be divided into six main categories: infectious, neoplastic, inflammatory, congenital or structural, iatrogenic, and idiopathic. Work-up of the atraumatic splenic rupture revealed that his HIV antibody was newly positive. He had a documented negative HIV antibody 3 weeks prior to the current admission. CD4 cell count, obtained after splenectomy, was 904 cells per microliter and the HIV-1 plasma RNA level was 4657 copies per milliliter. Spleen pathology demonstrated an enlarged spleen with increase in the number of small to intermediate size lymphoid cells in the red pulp, and reactive follicular lymphoid hyperplasia, with numerous secondary lymphoid follicles and reactive germinal centers in the white pulp. T-cell receptor (TCR) gene rearrangement studies demonstrated a positive TCR beta gene rearrangement, without a TCR gamma gene rearrangement, consistent with a clonal CD8(+) T-cell population. The case gives rare insight into what happens in the spleen during acute HIV infection and encourages HIV testing in those presenting with atraumatic splenic rupture. Counseling patients with acute HIV to avoid potential trauma should also be considered.

Life-threatening spontaneous splenic rupture with systemic lupus erythematosus: case report and literature review

“…Splenic rupture in the absence of trauma called spontaneous splenic rupture, which occurs suddenly or insidiously, was first described by Aktinson and is a rare complication of infectious, haematological and neoplastic disorders [1,2]. It has also been described in several rheumatic conditions [3].…”

ATraumatic Splenic Rupture: Dreaded Complication of Splenomegaly

“…It is a misleading term which would be better called atraumatic/non-traumatic or pathologic rupture since it almost always occurs in a diseased spleen due to an underlying pathologic process. A true spontaneous rupture that would occur without trauma and in a normal spleen is considered to be exceptionally rare and is still debated if it indeed occurs [2][3][4]. Even with splenic injuries from blunt trauma there has been found abnormal lymphocyte populations that may have contributed to the risk of rupture requiring splenectomy [2].…”

“…In a healthy adult it weighs between 75 and 250 g but decreases in size with age; it is usually 9-12 cm in length (cranio-caudal measurement) [4,7]. It lies beneath the 9 th to the 12 th thoracic ribs and is supplied by the splenic artery which is notable for its large size and tortuosity.…”

“…In the absence of cirrhosis, splenomegaly and variceal bleeding indicate splenic or portal vein thrombosis [4].…”

A medical approach to the treatment of atraumatic spontaneous spleen ruptures

“…There is not much information about the way of ASSR occurs, characteristics, and the frequency of its occurrence. The causes of ASSR can be infectious, neoplastic, haematological and iatrogenic (6,8). ASSR can be easily diagnosed by computerized tomography (CT) or laparotomy in hemodynamically unstable patients.…”