Splenosis and sepsis: The born-again spleen provides poor protection

Thoracic splenosis mimicking a pleuropneumonia

“…TS mainly occurs after gunshot wounds or motor vehicle injuries which can explain that most of cases of TS are described in men. [3,4,7,16] Abdominal splenosis is found to be associated in 24% of TS cases. [3] While peritoneal splenosis is frequently symptomatic with abdominal pain, gastrointesinal obstruction, or hydronephrosis, TS has been exceptionally described as the cause of hemoptysis, thoracic pain, or cough.…”

“…The absence of Howel–Jolly bodies or siderocytes in peripheral blood indicates the presence of functional splenic tissue (in patients with splenectomy). [4] Thirty years ago, diagnosis of TS was usually confirmed by studying tissue samples obtained by such invasive measures (thoracotomy, VATS, needle biopsy). [2,3,9] However it is now well-established, that a definitive diagnosis can be reached using non-invasive diagnostic tools such as imaging studies associated with functional study of the uptake of particles or cells: Tc-99 sulfur colloid scintigraphy, Tc-99 sulfur heat-damage erythrocytes scintigraphy, Tc-99 white blood cell scan or indium 111-labeled platelet, or super-paramagnetic iron oxide particles MRI.…”

“…It seems that when splenosis represents less than one-third of weight of the original spleen, host defenses are not restored, with poor phagocytic capacity, antibody response, or serum lyzozyme levels. [4,23,24] Incidence of OPSI in patients with splenosis is unknown, especially because most of human data come from case reports. Even though the absence of Howell–Jolly bodies (or of pitted erythrocytes as well) could suggest some recovery of macrophagic spleen function, the physician must keep in mind that the risk of OPSI, especially by encapsulated bacteria remains higher.…”

“…Even though the absence of Howell–Jolly bodies (or of pitted erythrocytes as well) could suggest some recovery of macrophagic spleen function, the physician must keep in mind that the risk of OPSI, especially by encapsulated bacteria remains higher. Indeed Connell et al [4] reported 16 cases of serious infections due to encapsulated bacteria, leading to death, despite a large amount of splenosis. These OPSI can occur up to 17 years after splenectomy.…”

Thoracic splenosis masquerading as advanced lung cancer

“…However, while the histology resembles normal splenic tissue, it is still associated with reduced immune function as the residual volume and function is insufficient to confer protection against overwhelming post-splenectomy infection, and therefore, the need for immunisation and early prophylactic penicillin remains. 3 In conclusion, thoracic splenosis should be considered in a patient presenting with asymptomatic left pleural nodules and a remote history of thoracoabdominal trauma, especially in the setting of known splenic injury and diaphragmatic rupture.…”