Abstract
Splenic abscess is often an unrecognized complication of enteric fever. Diagnosis is difficult because of its rarity, insidious onset, and non-specific presentation. We report an interesting case of splenic lesion in an immunocompetent adolescent with no other comorbidities, who presented with history and clinical presentation more suggestive of tubercular etiology. However, culture from the CT-guided fine-needle aspirate grew Gram-negative bacilli, identified as Salmonella Typhi which was sensitive to ampicillin, cotrimoxazole, azithromycin, and ceftriaxone. He responded favorably with oral antibiotics without any further surgical intervention. High degree of clinical awareness with timely and appropriate microbiological evaluation helped into an early definitive diagnosis of enteric splenic abscess. This case highlights that in this era of emerging infections, we should not miss the atypical presentations of the endemic diseases. Safe and minimally invasive radiological intervention with good microbiological correlation is a successful spleen conserving treatment alternative to surgery in suitable patients of splenic abscess.
Highlights
Splenic abscess is a rare entity among immunocompetent adults, with a reported incidence in autopsy series between 0.14% and 0.7 % [1]
Diagnostic aspiration has a high yield in establishing the diagnosis and appropriate antibiotic therapy is the cornerstone of management [2]
We report an interesting case of splenic lesion clinically mimicking tubercular etiology, but was identified as enteric splenic abscess and successfully managed by noninterventional approach
Summary
Splenic abscess is a rare entity among immunocompetent adults, with a reported incidence in autopsy series between 0.14% and 0.7 % [1]. His abdominal examination revealed tenderness on the left hypochondrium with mild distention, while the remainder of his examination was unremarkable It was Gram-negative bacilli which was motile, alkaline/acid reaction without gas in triple sugar iron agar (TSI), citrate utilizing and positive reaction for methyl red reaction. Given the diagnosis of enteric splenic abscess, the patient was commenced on oral cotrimoxazole for a total duration of 4 weeks with vitamin supplements. He responded favorably without any further surgical intervention. On 6 months follow-up, he had clinically recovered and alleviated of symptoms
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