Splenic Infarction Research Articles

Acute on Chronic Limb-Threatening Ischemia Associated with Septic Embolism in Patient with Infective Endocarditis

Septic embolism associated with infective endocarditis (IE) is the occlusion of a blood vessel caused by an infected thrombus traveling through the bloodstream resulting in ischemia and/or infarction. Septic embolism can result in ischemia and/or infarction due to vascular occlusion and infection, resulting in inflammation and possible abscess formation. Systemic embolization generally occurs in left-sided IE, causing stroke, blindness due to embolism or endophthalmitis, splenic or renal infarct, limb ischemia, or even acute myocardial infarction. Here, we report a case of acute on chronic limb-threatening ischemia due to septic embolism in patient with IE.

Lactococcus lactis endocarditis and liver abscess in an immunocompetent patient: a case report and review of the literature

BackgroundOver the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections.Case presentationA 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcuscremoris, is a rare cause of human infections. The first case of Lactococcus lactiscremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases.ConclusionsTo our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.

CHALLENGES IN DIAGNOSING SPLENIC ABSCESSES IN HIV-INFECTED PATIENTS

Objective: Improve the quality of treatment for HIV-infected patients with heart attacks and splenic abscesses by optimizing the diagnosis of these pathological processes. Material and Methods: From 2004 to 2019, 14,405 HIV-infected patients, including 34 patients with suspected splenic abscesses, were treated in the surgical department of the Infectious Clinical Hospital State Budgetary Healthcare Institution (ICH SBHI) No.2. The average age was 34.9 years, 22 males and 12 females. Three patients had stage 3, ten people had stage 4A, ten patiens had stage 4B, and eleven people had stage 4B HIV infection. Patient management followed the generally approved algorithms of the Ministry of Health of the Russian Federation for surgical patients (taking into account the HIV-infection co-morbidity). The following was done: complaints and anamnesis were collected, the duration of HIV-infection, adherence to ART, presence of opportunistic and concomitant diseases were carefully determined, an abdominal ultrasound imaging and an abdominal CT scan were performed. Four patients were diagnosed with splenic infarction; they were treated conservatively and discharged in a satisfactory condition. Surgical treatment was performed in 30 out of 34 patients in the period from 1 to 57 days from admission to the hospital, usually on day 9. 26 of them were discharged and 4 patients died. All 30 surgical patients received antibiotic therapy, surgical material was examined histologically, the cause of the splenic process was determined and therapy was adjusted (if tuberculosis had been diagnosed, patients were moved to an anti-TB hospital, if lymphoma had been diagnosed, patients were moved to an oncohematology department). Results: When examining HIV-infected patients with complaints of abdominal pain and hyperthermia, a detailed history of HIV infection, adherence to ART, viral load and immune status (if the patient knows these data), the presence of concomitant pathological conditions should always be clarified, as wells as abdominal ultrasound and abdominal CT scan should be performed as early as possible. All surgical materials should be examined histologically to verify the cause of the splenic process. Patients in stages 4B-4B, not adhering to ART, with a high viral load and low immune status, suffering from drug addiction and HCV infection, more often get complicated forms of the disease.

Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: systematic literature review

Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: systematic literature review

SICKLE CELL THALASSEMIA IN AN ADULT FROM CENTRAL INDIA SHOWING MASSIVE SPLENIC INFARCTION AND GAMNA-GANDY BODIES IN SPLENIC PARENCHYMA WITH CONCOMITANT PLASMODIUM FALCIPARUM INFECTION

Background. Sickle cell thalassemia is a heterozygous state of HbS/β+ or HbS/β0 manifested clinically either as an asymptomatic carrier or have features akin to sickle cell anemia. Objective. The aim of the study is to review the literature and discuss the varied clinical manifestations and diagnosis of a case report of haemoglobinopathy in an adult from Central India. Methods. A case of haemoglobinopathy from central part of India is being investigated. Results. A case of haemoglobinopathy in an adult presenting to a tertiary hospital with chronic back ache was reported. The patient was found to have massive splenomegaly with evidence of splenic infarction. Gross examination of spleen revealed multiple soft yellowish pasty areas, which on microscopic examination showed significant necrosis with presence of great amount pale amorphous yellow substance, Gamna-Gandy bodies (GGBs) and massive foreign body cell reaction in splenic parenchyma. Post-splenectomy peripheral blood smear (PBS) showed thrombocytosis and plasmodium falciparum gametocytes. The Hb electrophoresis revealed both elevation of Hb S (49.7%), Hb F (46.7%); Hb A2 (3.0%) and (Hb A 0.7%) consistent with as Sickle Cell Thalassemia Hb S/β+ Thalassemia. Conclusion. Sickle cell thalassemia with long standing huge splenomegaly, splenic infarction with GGBs deposition and concomitant falciparum malaria in clinically stable patient is rare indeed.

Partial Splenic Artery Embolization in the Management of Acute Immune Thrombocytopenia Refractory to Medical Treatment

Our case details a 60-year-old man with cirrhosis from hepatitis C referred to hematology for severe thrombocytopenia after right hemiglossectomy in the setting of squamous cell tongue cancer. Acute immune thrombocytopenia was diagnosed. Platelet transfusions, high-dose steroids, intravenous immunoglobulin ×2, romiplostim, and rituximab were administered without adequate platelet response (2000/µL), and patient developed gastrointestinal bleeding. Partial splenic artery embolization was performed urgently for refractory thrombocytopenia resulting in ∼60% splenic infarction. His platelet count increased in the next few days and was sustained. Our case demonstrates partial splenic artery embolization as an underused approach to severe thrombocytopenia in the setting of acute immune thrombocytopenia resistant to steroids and medications.

Imaging case series of melioidosis: the great masquerader

BackgroundMelioidosis is an infectious disease caused by Gram-negative bacterium Burkholderia pseudomallei. It is endemic to Southeast Asia. Inhalation, inoculation and ingestion are major routes of transmission. Increased risk of infection is seen in patients with diabetes, alcoholism, chronic renal and liver failure and malignancy. The aim of the present case series is to describe the varied imaging manifestations of melioidosis.Case presentationThis is a retrospective review of imaging findings in eight patients with culture-proven B. pseudomallei infections diagnosed in our institute from September 2019 to September 2021. A total of eight culture-proven melioidosis cases were reported from our institute. All of them had multiorgan involvement and predisposing conditions or risk factors, most common being diabetes mellitus and alcoholism. Lung was the most common organ involved showing nodules and consolidations followed by liver and spleen demonstrating multiple ‘honeycomb’-like abscesses. Musculoskeletal manifestations included osteomyelitis and intramuscular abscess. Cerebral abscess, cerebral infarcts, prostatic abscess, abdominal aortic mycotic aneurysm with periaortic hematoma and splenic vein thrombosis with splenic infarcts were a few other manifestations.ConclusionsMelioidosis is a great mimicker with acute, subacute or chronic clinical course involving multiple organs and resembling other common infections. Hence, it should be considered as a possible etiological agent when evaluating patients with risk factors and multiorgan involvement.

An unusual manifestation of scrub typhus presenting with splenic infarct: a case report

Scrub typhus has a wide range of clinical presentation varying from mild symptoms like fever, chills, headaches, myalgias, gastric ulcerations and hepatitis to more fatal conditions like pneumonia and encephalopathy caused by disseminated vasculitis with splenic infarct being a rare complication. We report a case of 50-years old male with scrub typhus who presented as multiple splenic infarcts.

Fatal infective endocarditis early after TAVR.

A 75-year-old patient who had received Evolut R 34 TAVR prosthesis for severe aortic stenosis 2 months prior, presented for dyspnea, altered mental status and abdominal pain. Three blood cultures sets tested positive for Enterococcus faecalis. Transthoracic echocardiography was limited by a poor acoustic window, prompting for transesophageal echocardiography, which revealed an echo-free gap between the prosthesis and the posterior aortic wall suggesting the possibility of a periprosthetic abscess (Panel A). Cardiac CT found an abscess between the metal structure of the prosthesis and the noncoronary aortic sinus (Panel B, arrow and Panel C, top arrow), as well as filling defects suggesting vegetations at the level of the biological valve and of the metal structure of the prosthesis (Panel C, buttom arrow and Panel D, arrow). Two aortic pseudoaneurysms in relation to the distal extremity of the endoprosthesis’s stent were also present (Panel D and E, arrowhead). Multiorgan CT scans performed as a part of the IE imaging approach revealed multiple recent ischemic lesions in the brain (Panel F), as well as hepatic, splenic and renal infarcts (Panel G). Given the severe neurological deficit caused by the stroke, the patient was not a candidate for surgical prosthesis replacement. During the monitoring, the patient presented worsening of the symptoms and he died on Day 7 of his hospitalization. Our case emphasizes the possibility of a negative outcome after TAVR, as well as the role of imaging in the diagnosis of early infective endocarditis after TAVR.1,2

Proximal Splenic Artery Embolization for Refractory Ascites and Hydrothorax Post-Liver Transplant.

Proximal splenic artery embolization (pSAE) has been advocated as a valuable tool to ameliorate portal hyper-perfusion (PHP). The purpose of this study was to determine the safety and efficacy of pSAE to treat refractory ascites (RA) and/or refractory hydrothorax (RH) in the setting of PHP post-liver transplant. A total of 30 patients who underwent pSAE for RA and/or RH after liver transplantation (LT) between January 2007 and December 2017 were analyzed retrospectively. The patients were divided into groups according to the time frame from pSAE to clinical resolution in order to identify predictors of RA/RH response to the procedure. Twenty-four (80%) patients responded to pSAE within three months, whereas 6 (20%) still required additional treatments for RA/RH at three months post-pSAE. In all cases clinical symptoms resolved within six months. Complications after pSAE were as follows: 2 cases of splenic infarction (6.6%), one case of post-splenic embolization syndrome (3.3%), one case of hepatic artery thrombosis (3.3%) and one case of portal vein (PV) thrombosis (3.3%). Increased intraoperative PV flow volume and increased pre-pSAE PV velocity, as well as higher estimated glomerular filtration rate were associated with early RA/RH resolution. pSAE is safe and effective in treating RA and RH due to PHP after LT. This study suggests that clinical parameters indicating more severe PHP and better kidney function are possible predictors for early response to pSAE.

Lessons in IR: Splenic Infarct after Splenic Aneurysm Embolization

Lessons in IR: Splenic Infarct after Splenic Aneurysm Embolization

Role of pre and post oral and IV contrast MDCT scan of the abdomen in assessment of early complications after laparoscopic sleeve gastrectomy (LSG)

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgical procedure. Abdominal CT scan is a preferred useful modality in detection of early post sleeve gastrectomy complications, namely staple line leakage, bleeding, mesenteric vascular thrombosis and splenic infarction. The aim of our study is to assess the value of abdominal MDCT in diagnosis of suspected early complications following laparoscopic sleeve gastrectomy operations.MethodsData collection included clinical and laboratory data from the referral requests written by the surgeons. MDCT scan then was performed for all patients. Follow-up clinical data for all patients and follow-up surgical findings for some patients who needed surgical intervention were collected and correlated with the CT findings.ResultsThis prospective study included 75 patients referred by their surgeons as clinically suspected to have acute post LSG complications. MDCT scan was done for all those patients and detected multiple post-operative complications in 68 patients (91%) with the most common one was staple line gastric leak in 30 patients (40%), other complications were also detected as intra-abdominal abscess, porto-mesenteric thrombosis, splenic infarction and pulmonary complications. CT findings were correlated with the clinical, surgical and laboratory data of the patients as well as the follow-up findings.ConclusionsMDCT scan is a reliable imaging modality for detecting acute post LSG complications and correlates well with both the clinical presentation and patient's follow-up data.

Monoclonal gammopathy of thrombotic/thrombocytopenic significance

Letter to Blood| April 6, 2023 Monoclonal gammopathy of thrombotic/thrombocytopenic significance Adam J. Kanack, Adam J. Kanack Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Jordan K. Schaefer, Jordan K. Schaefer Department of Medicine, University of Michigan, Ann Arbor, MI https://orcid.org/0000-0002-7166-386X Search for other works by this author on: This Site PubMed Google Scholar Meera Sridharan, Meera Sridharan Department of Medicine, Mayo Clinic, Rochester, MN https://orcid.org/0000-0001-7225-8228 Search for other works by this author on: This Site PubMed Google Scholar Noah P. Splinter, Noah P. Splinter Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Mindy C. Kohlhagen, Mindy C. Kohlhagen Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Bandana Singh, Bandana Singh Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Silvana B. De Lorenzo, Silvana B. De Lorenzo Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Emily E. Mauch, Emily E. Mauch Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Maen A. Hussein, Maen A. Hussein Florida Cancer Specialists, Orlando, FL Search for other works by this author on: This Site PubMed Google Scholar Marwan Shaikh, Marwan Shaikh Department of Medicine, Mayo Clinic, Jacksonville, FL Search for other works by this author on: This Site PubMed Google Scholar Shaji Kumar, Shaji Kumar Department of Medicine, Mayo Clinic, Rochester, MN https://orcid.org/0000-0001-5392-9284 Search for other works by this author on: This Site PubMed Google Scholar Renren Wen, Renren Wen Department of Microbiology and Immunology, Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI https://orcid.org/0000-0003-2420-8212 Search for other works by this author on: This Site PubMed Google Scholar Demin Wang, Demin Wang Department of Microbiology and Immunology, Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI https://orcid.org/0000-0001-5549-3795 Search for other works by this author on: This Site PubMed Google Scholar David Murray, David Murray Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Anand Padmanabhan Anand Padmanabhan Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN https://orcid.org/0000-0003-2519-4377 Search for other works by this author on: This Site PubMed Google Scholar Blood (2023) 141 (14): 1772–1776. https://doi.org/10.1182/blood.2022018797 Article history Submitted: October 19, 2022 Accepted: December 27, 2022 Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Request Permissions Cite Icon Cite Search Site Citation Adam J. Kanack, Jordan K. Schaefer, Meera Sridharan, Noah P. Splinter, Mindy C. Kohlhagen, Bandana Singh, Silvana B. De Lorenzo, Emily E. Mauch, Maen A. Hussein, Marwan Shaikh, Shaji Kumar, Renren Wen, Demin Wang, David Murray, Anand Padmanabhan; Monoclonal gammopathy of thrombotic/thrombocytopenic significance. Blood 2023; 141 (14): 1772–1776. doi: https://doi.org/10.1182/blood.2022018797 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsBlood Search Subjects: Thrombosis and Hemostasis TO THE EDITOR: Anti–platelet factor 4 (PF4) antibodies have a central role in the pathophysiology of thrombosis and thrombocytopenia in heparin-induced thrombocytopenia (HIT)1,2 and vaccine-induced immune thrombotic thrombocytopenia (VITT).3-7 Here, we present the case of a patient with recurrent thrombosis and thrombocytopenia, secondary to a persistent anti-PF4/polyanion monoclonal antibody due to an underlying neoplastic condition, which we refer to as monoclonal gammopathy of thrombotic/thrombocytopenic significance (MGTS). The implications of these findings for the investigation of unexplained thrombophilia are discussed. A 64-year-old man presented for evaluation of recurrent thrombotic episodes. His medical history included segmental and subsegmental pulmonary emboli, portal vein thrombosis, non-ST elevation myocardial infarction, splenic infarction, and ST elevation myocardial infarction (Figure 1A). Extensive investigations performed did not support a thrombophilia diagnosis (supplemental Table 1 and supplemental Materials; available on the Blood website). His...

A case of late and lethal Trousseau's syndrome induced by pembrolizumab in lung adenocarcinoma.

Trousseau's syndrome is arelatively rare reported eventin immunotherapy-related clinical trials, mostly occurring in the early period of immune checkpoint inhibitor (ICI) therapy. Here, we report an unusual case of late and lethal Trousseau's syndrome during pembrolizumab maintenance therapy in a lung adenocarcinoma harboring tumor protein p53 (TP53) mutation. The patient has experiencedsevere coagulation abnormalities manifesting as cerebral infarction, partial infarction of both kidneys and spleen after 23 cycles of pembrolizumab useand wasresistant to anticoagulants. The late occurrence of coagulation abnormalities in this case reveals a possible correlation between TP53 mutations and Trousseau's syndrome when patients are treated with ICIs.

Clinical characteristics of 14 pediatric mycoplasma pneumoniae pneumonia associated thrombosis: a retrospective study

ObjectiveThis study aimed to investigate the clinical characteristics and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP)-associated thrombosis and to gain a better understanding of the diagnosis and treatment of the disease.MethodsThe medical records of 14 children with MPP-associated thrombosis between January 2016 and April 2020 were retrospectively reviewed at the Tianjin Children’s Hospital.ResultsThe ages of the patients ranged from 3 to 12 years old. Among the 14 cases, there were five cases of pulmonary embolism, two cases of cerebral infarction, one case of splenic infarction, one case of cardiac embolism, two cases of cardiac embolism with comorbid pulmonary embolism, one case of internal carotid artery and pulmonary embolism, one case of combined internal carotid artery and the cerebral infarction, and one case combined cardiac embolism and lower limb artery embolism. All cases had elevated D-dimer levels. After thrombolysis and anticoagulation therapy, three cases with cerebral embolism still suffered from neurological sequelae. In contrast, the remaining cases did not develop complications.ConclusionMPP-associated thrombosis can occur in any vessel of the body. Thrombosis-associated symptoms may be complex and non-specific. Elevated D-dimer levels in a child with refractory mycoplasma pneumoniae pneumonia should raise suspicion of thrombosis. The long-term prognosis of thrombosis was favorable after the timely administration of anticoagulant therapy.

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review.

Splenic infarction is a frequently missed diagnosis in acute clinical conditions and is often under-diagnosed due to the lack of high-quality evidence on pathophysiology of splenic infarction. Due to the scarcity of such evidence, no consensus guidelines regarding the diagnostic approach and management of patients with splenic infarction exist. Most of published articles on splenic infarction are case reports and there was no systematic review on splenic infarction. We conducted a retrospective analysis of all radiologically confirmed cases of splenic infarction patients with any history of admission at National Center for Global Health and Medicine Kohnodai Hospital, from 2014 to 2020. Further, to understand the pathophysiology that causes splenic infarction, we searched the literatures on splenic infarction. We found 18 patients with splenic infarction. The average age was 78 years, and about half of patients had abdominal pain; however, the other half did not have abdominal pain. One-third of patients with splenic infarction died. Leukocytosis with neutrophilia, a decrease of lymphocytes, anemia, hypoalbuminemia, and liver dysfunction were observed. Fibrinogen was decreased and D-dimer was remarkably elevated. Lactate dehydrogenase (LDH) and C-reactive protein (CRP) were remarkably increased. Six patients (33.3%) had cancer, four patients (22.2%) had atrial fibrillation, and four patients (22.2%) had infection. We found 466 case reports on splenic infarction published from 1975 to 2021. Recently, the number of case reports on splenic infarction due to infection, especially, coronavirus disease 2019 (COVID-19), has been remarkably increasing. Furthermore, we found that leukocytosis, a decrease of lymphocytes, elongated activated partial thromboplastin time, decrease of fibrinogen, liver dysfunction, elevation of LDH and blood urea nitrogen can be the prognosis predicting factors for patients with splenic infarction. Our study elucidated clinical, hematological, biochemical and radiological characteristics for patients with splenic infarction. We newly found significant differences in blood cell counts, coagulation markers, transaminases, LDH and blood urea nitrogen between patients who died and those who survived, suggesting that these parameters can be the prognosis predicting factors for splenic infarction. Further, our systematic review on case reports about splenic infarction showed the etiology of splenic infarction and the trend of the causative diseases.

Wandering Spleen: A Rare Condition with Splenic Torsion and Infarction in an Elderly Patient

Ectopic spleen or wandering spleen is an uncommon presentation in which the spleen's anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen.

Splenic infarction as a first clinical manifestation of sickle cell/beta+ thalassemia: a case report

Background: An association between splenic infarction, high altitude, and different subtypes of sickle cell disease (SCD) has been reported in the literature, particularly sickle cell trait. However, none of these studies reported the possibility of splenic infarction as a presenting feature of sickle cell/beta+ thalassemia. Case Presentation: A 23-year-old male college student presented to the emergency department with dull pain in the left upper quadrant and without any known history of medical illness. The patient was originally from Qatif, the Eastern Province of Saudi Arabia, and was referred to the study hospital with an ultrasound report showing splenic infarction. Upon presentation to the study hospital, the patient still had mild abdominal pain and early satiety. Examination revealed tachycardia (128/minute), upper abdominal tenderness, and splenomegaly approximately 2-3 cm below the left costal margin, with thrombocytosis and high lactate dehydrogenase (LDH) levels. Hemoglobin (HGB) electrophoresis showed hemoglobin A (HbA) 19.3; HbA2 4.9; hemoglobin F 12.9 and hemoglobin S 62.9, confirming a diagnosis of sickle cell/beta+ thalassemia. The patient was started on IV hydration and therapeutic anticoagulation with enoxaparin 60 mg subcutaneously every 12 hours. The patient's symptoms improved. Therefore, the patient was discharged on life-long apixaban (5 mg PO Bid), with close follow-up at the hematology clinic. Conclusion: Splenic infarction could be manifested as an isolated feature in patients with SCD and its subtypes, such as sickle cell beta+ thalassemia. Therefore, physicians should pay careful attention to these complications and consider HGB electrophoresis as a part of the workup.

Personalized Management of Chronic Myeloid Leukemia Presenting with Ovarian Apoplexy and Review of Health Emergency Cases

Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.

Relato de caso de infarto esplênico em uma criança com atresia biliar

This case report is intended to describe a rare case of splenic infarction (SI) associated with biliary atresia, which contributed to the worsening of the prognosis. In this case study, a boy diagnosed with biliary atresia underwent the Kasai procedure at the age of 3 months. The patient presented an intense abdominal pain, ascites and fever at the age of 6 years. A computed tomography (CT) scan showed enlargement of the spleen and an image suggestive of SI. The symptoms improved with the administration of antibiotics, analgesics, while ascites decreased with the use of diuretics. Liver transplantation was indicated. SI is an extremely rare event characterized by vessel occlusion, parenchymal ischemia and tissue necrosis. The symptoms are non-specific and may be confounding factors with other causes of acute abdominal pain. Splenomegaly-inducing diseases may be a risk factor. There are few case reports of SI and cirrhosis of different etiologies in childhood. Abdominal CT scan with intravenous contrast is the imaging modality of choice and the treatment ranges from supportive care to splenectomy. Despite being a rare condition, its knowledge is extremely important, as it allows early clinical suspicion, with immediate institution of treatment, which may interfere with the prognosis.