Two cases of salmonella splenic abscess

Abstract

Splenic abscess is a rare clinical entity with an incidence of 0.2 to 0.7 percent in autopsy based studies [1]. Less than 500 cases have been reported in world literature. Clinical presentation is non-specific and it is a potentially serious surgical problem associated with high mortality. The treatment has been a combination of total splenectomy or percutaneous drainage and appropriate antibiotic therapy. We report 2 cases who developed multiple splenic abscesses and were successfully treated. Case 1 A 21 year old man presented with high-grade intermittent fever with chills and rigors and productive cough of 10 days duration. On examination he had fever, left sided pleural rub and a palpable liver, 2cms below the right costal margin. Investigation showed a Hb of 13gm/dl; TLC 6900/cmm; DLC N48 L48 E03M02; blood sugar 71 mg/dl; bilirubin 0.9 mg/dl, SGOT 76 U/L, SGPT 56 U/L; blood urea 30 mg/dl and serum creatinine 1.3 mg/dl. Peripheral blood smear revealed leucocytosis with shift to left and toxic granules. Chest radiograph showed elevated left hemi-diaphragm. Lung parenchyma and costophrenic angles were normal. Abdominal ultrasonography (USG) showed splenomegaly with multiple hypoechoic areas measuring few mm to 6 cms in diameter. The Widal test was negative. Blood culture and bone marrow aspiration culture were sterile. Contrast enhanced computerized tomography of abdomen confirmed multiple hypodense lesions suggestive of splenic abscess. Injection ceftriaxone and amikacin were instituted. A USG guided percutaneous aspiration was done and 400ml of haemorrhagic pus was drained. Ziehl Neelsen and gram's stain were negative for bacteria. Pus culture grew Salmonella typhi. The fever persisted inspite of antibiotics and patient developed hypotension. A surgical consultation was sought and he underwent emergent splenectomy. The fever subsided from 3rd postoperative day and the general condition improved. Antibiotics were continued for 4 weeks. Sickling and HIV test were negative.