Abstract
Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.
Highlights
Severe acute respiratory syndrome (SARS) coronavirus(CoV-) 2 (SARS-CoV-2), the etiological agent that causes coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization (WHO) in March 2020, presents principally as a lower respiratory tract infection, but the multisystemic nature of the disease is evident in severe cases
It is important to know the importance of splenic infarction as a thrombotic complication of COVID-19, considering the fact that in the pre-COVID-19 era the diagnosis for this case would have been “spontaneous rupture of spleen,” since other diagnostic hypotheses could not be formulated
Thrombotic events are one of the main complications of SARS-CoV-2 infection, reports and imaging findings of splenic infarction are rare in the literature
Summary
Severe acute respiratory syndrome (SARS) coronavirus(CoV-) 2 (SARS-CoV-2), the etiological agent that causes coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization (WHO) in March 2020, presents principally as a lower respiratory tract infection, but the multisystemic nature of the disease is evident in severe cases. A broad spectrum of symptoms associated with COVID-19 has been identified. These range from asymptomatic disease to mild and moderate symptoms and severe symptoms associated with critical illness resulting in acute respiratory distress syndrome, respiratory failure or multiorgan dysfunction, and/or death [1, 2]. The atraumatic rupture of the spleen is widely documented in the literature and is associated with a previous pathological finding in 93% of cases [5]. The case we present here shows the occurrence of an atraumatic splenic rupture secondary to SARSCoV-2 infection
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