Splenic abscess associated with infective endocarditis; Case series

Abstract

Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can be fatal. We present three case reports that describe the management of splenic abscesses in patients initially diagnosed with infective endocarditis. In all cases, the diagnosis was based on the findings of abdominal computed tomography (CT) scan or magnetic resonance imaging (MRI). In two of the cases, splenectomy was performed before valve surgery; while in the third case, the spleen was removed after cardiac surgery. All three patients recovered fully, with satisfactory follow-up as outpatients. Immediate splenectomy, combined with appropriate antibiotics and valve replacement surgery alongside multi-disciplinary team work could be the treatment of choice in this clinical scenario.

Systemic Infection and Splenic Abscess

“…Furthermore, both patients had multiple negative blood cultures after the initial positive culture, but despite aggressive antibiotic therapy, neither improved. In general, patients with infective endocarditis or other forms of severe bacterial sepsis with abdominal pain or swelling or with prolonged fever despite appropriate antibiotic therapy should be considered for abdominal imaging in search of a splenic abscess (5).…”

Surgical Management of Coexisting Primary Splenic Abscess and Lymphoma: Case Report and Review of Literature

“…While these conditions may explain a single splenic abscess, multiple splenic abscesses are rare, which, in the setting of lymphoma has not been previously reported. Documented splenic abscesses have occurred after sleeve gastrectomies postulating the cause from immunosuppression in the setting of rapid weight loss, limited oral intake and in conjunction with endocarditis [2,3]. Around 44% of patients present with left upper quadrant pain, fever, and leukocytosis.…”

Septic Embolism: A Potentially Devastating Complication of Infective Endocarditis

“…Although often asymptomatic, splenic infarct may be associated with acute abdominal (usually left upper quadrant) pain and can be complicated by abscess formation (the primary source of subsequent morbidity and mortality) [12,77]. Splenic abscess formation is due to hematogeneous spread from a distant source of infection, with IE being associated with up to two-thirds of such instances, either via bacteremic seeding or direct embolization of infected valvular debris [78,79].…”

“…Streptococci and staphylococci are among the most common offending microorganisms, accounting for >80% of cases [4,12]. While Streptococcus viridans and Staphylococcus aureus are frequently encountered, other bacterial species including K. pneumoniae, S. epidermidis, and P. mirabilis have been described in this setting [79].…”