Spontaneous rupture of the spleen associated with pneumonia

Abstract

Spontaneous rupture of the spleen is a rare and life-threatening complication of bacterial pneumonia, only six properly documented cases having been reported to date. A case of spontaneous splenic rupture associated with pneumonia caused by Legionella pneumophila is presented, together with a review of the literature. Most of the patients were aged over 50, but none had predisposing conditions. Left lung involvement predominated. Legionellosis and Q fever were the most frequent etiologic diagnoses. Empiric antibiotic therapy was adequate in all but two patients. One patient died; he had not undergone laparotomy. Spontaneous rupture of the spleen is an extremely rare complication of bacterial pneumonia that endangers the patient's life if surgery is not performed immediately. This complication should be borne in mind in patients with atypical pneumonia who have left quadrant pain and a falling hematocrit, even in the absence of prior splenomegaly.

Splenic rupture in community acquired pneumonia: A case report

“…Of the infectious causes, 40% are attributed to EBV and 17% to Malaria (Plasmodium vivax or falciparum) but there are numerous other organisms that have been implicated [2]. Atraumatic rupture secondary to cough and/or pneumonia is particularly rare, with only 12 reported cases since 1980 [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Streptococcus pneumoniae, Haemophilus influenza, Q fever and Legionella have been identified as pathogens.…”

Occult splenic rupture with cardiovascular collapse: a report of three cases in critically ill patients

“…The diagnosis is normally suspected from the history and symptoms of left hypochondriac pain radiating to the shoulder, it is also suspected from signs of abdominal swelling and hypovolaemia [2]. Rupture may also occur after iatrogenic trauma including CPR [8] and endoscopic procedures [9,10] or after minimal trauma, such as coughing, [3] vomiting [4,11] or the trauma associated with prone positioning in the treatment of adult respiratory distress syndrome [12]. The spleen may also rupture without any obvious trauma; pathological conditions that pre-dispose to this include infections, including infectious mononucleosis [6], and tropical diseases like malaria [7].…”

“…The spleen may also rupture without any obvious trauma; pathological conditions that pre-dispose to this include infections, including infectious mononucleosis [6], and tropical diseases like malaria [7]. The spleen may also rupture as a complication of haematological malignancy [13] and as a result of its increased friability after sepsis [4,5] and pneumonia [3,5,14]. Rupture may also be associated with rheumatoid conditions [15] and anticoagulation with warfarin or heparin, thrombolysis with streptokinase [16] and even prophylactic heparin use [17].…”

“…In sepsis, the spleen is engorged due to expansion of the red pulp and leukocyte infiltration and the capsule is friable due to cellular infiltrate [5]. This immunological stimulation may then make the spleen vulnerable to rupture [3,5], even after trivial insults like coughing [3,5,14].…”

“…It may, however, present days after the original trauma [1] and may occur spontaneously [2] or after only minor trauma [3,4]. Spontaneous rupture or rupture after minimal trauma is more likely when the spleen is already abnormal [5,6,7].…”