Possible infectious causes of spontaneous splenic rupture: a case report

Lam, Grace Y.; Chan, Adrienne K.; Powis, Jeff

doi:10.1186/1752-1947-8-396

Cited by 16 publications

(20 citation statements)

References 18 publications

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“…The Orloff and Peskin criteria are used to establish the diagnosis of atraumatic idiopathic splenic rupture (box 1). 2 Crate and Payne have added a fifth criterion stating that full virological studies of acute phase and convalescent serum should show no significant rise in antibody titres suggesting recent viral infections 11. Individuals may present to the emergency department with an acute abdomen and hypovolaemic shock.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma

Dunphy¹,

Abbas

Patel

et al. 2019

BMJ Case Rep

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Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening entity. It can be due to neoplastic, infectious, haematological, inflammatory and metabolic causes. An iatrogenic or an idiopathic aetiology should also be considered. Depending on the degree of splenic injury and the haemodynamic status of the patient, it can be managed conservatively. A 61-year-old man presented to the emergency department with an acute abdomen, hypovolaemic shock and clotting abnormalities. However, his focused assessment with sonography for trauma showed no evidence of an aortic aneurysm, rupture or dissection. Further investigation with a CT angiogram aorta confirmed a subcapsular splenic haematoma with free fluid in the pelvis and a mass in the superior pole of the spleen. He was diagnosed with an SSR. He was initially managed non-operatively. However, his repeat CT showed an enlarging haematoma and he underwent embolisation of his splenic artery. Ultrasound-guided core biopsy of his splenic mass confirmed the diagnosis of diffuse large B-cell lymphoma. This paper will discuss the clinical presentation, differential diagnosis and management of SSR. Furthermore, it provides an important clinical lesson to maintain a high index of clinical suspicion for splenic injury in patients presenting with left upper quadrant abdominal pain radiating to the shoulder. This case also reinforces the importance of close observation and monitoring of those individuals treated conservatively for signs of clinical deterioration.

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Section: Discussionmentioning

confidence: 99%

“…The Orloff and Peskin criteria, containing four variables, are used to establish the diagnosis of atraumatic idiopathic splenic rupture 1box 1) Crate and Payne added a fifth criterion including virological studies of acute phase and convalescent serum 2…”

Section: Introductionmentioning

confidence: 99%

Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma

Dunphy¹,

Abbas

Patel

et al. 2019

BMJ Case Rep

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“…The presence of left shoulder pain in this setting is known as Kehr’s sign and is present in 17% of patients with ASR[17]. Diagnosis of infectious mononucleosis consists of appropriate clinical findings (the “classical triad” of fever, pharyngitis and lymphadenopathy) and serological evidence (detection of anti-viral capsid antigen IgM antibodies)[18]. Approximately 0.5% of these patients will suffer from ASR with an associated mortality rate of 9%-30%[5,19,20].…”

Section: Discussionmentioning

confidence: 99%

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

Kwok¹

2019

WJGS

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BACKGROUNDAtraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.CASE SUMMARYA 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.CONCLUSIONThis case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.

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“…Spontaneous splenic rupture is usually due to neoplastic, infectious, haematological, inflammatory, metabolic, iatrogenic or idiopathic. Neoplasia and infectious causes accounts for more than half of the cases [4].…”

Section: Discussionmentioning

confidence: 99%

Non-Traumatic Spontaneous Splenic Rupture: A Rare Initial Presentation of Chronic Myeloid Leukaemia

A¹

2017

OAJS

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Chronic myeloid leukaemia (CML) is a myeloproliferative disorder, usually asymptomatic and diagnosed incidentally with an elevated WBC counts on a routine laboratory tests. Its presentation in emergency as hem peritoneum is extremely rare. Here we report a rare case of CML presented to us as spontaneous splenic rupture. A 20-year female presented with generalised abdominal pain for past 2 days with no history of trauma. On examination, patient was in shock and abdomen was distended with generalised guarding and rigidity. Ultrasound abdomen revealed enlarged liver and spleen with large fluid collection in the pelvis suspecting haemorrhage.After adequate resuscitation, patient was taken for exploratory laparotomy. Intraoperatively there was a massively enlarged spleen with bleeding actively from its superior pole. Splenectomy was done. Post operatively, patient was diagnosed as chronic myeloid leukaemia by peripheral smear and bone marrow study in view constantly elevated white blood counts. Spontaneous splenic rupture is a rare but potentially life-threatening entity. It usually occurs in pathologically enlarged spleen where rupture occurs because of infiltration of spleen by malignant cells. High index of suspicion is required to clinch the diagnosis in non-traumatic patients.

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Possible infectious causes of spontaneous splenic rupture: a case report

Cited by 16 publications

References 18 publications

Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma

Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

Non-Traumatic Spontaneous Splenic Rupture: A Rare Initial Presentation of Chronic Myeloid Leukaemia

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