Splenic abscess associated with endocarditis in a patient on hemodialysis: a case report

Abstract

Splenic abscess is an unusual condition usually seen in immunocompromised patients or associated with intravenous drug abuses. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess. Splenic abscess in a patient on hemodialysis is a rare but life-threatening condition if not corrected. We describe a case of splenic abscess with bacterial endocarditis on maintenance hemodialysis. He had staphylococcal septicemia secondary to bacterial endocarditis at the mitral valve from the dialysis access-site infection. Although hematologic seeding from endocarditis has been the predisposing factor for splenic abscess, we postulate that access-site infections may predispose hemodialysis patients to splenic abscess. Splenic abscess may be considered as one of the causes when patients on hemodialysis develop unexplained fever.

Fig. 1

Abdominal sonography reveals two hypoechoic space occupying lesions and one cystic lesion in the spleen.

Fig. 2

Abdominal CT reveals multiple septated cystic lesion in the spleen, the largest 4.3 cm, compatible with multiple splenic abscesses.

Fig. 3

Gross finding of removed spleen shows abscess pockets.

Fig. 4

Pathologic findings showed the splenic abscess (H&E,×100).