Concomitant necrobiosis lipoidica and splenic abscess

Abstract

Necrobiosis lipoidica is an idiopathic dermatosis of unknown origin, occurring mainly in patients with diabetes. Splenic abscesses are rare entities. We report a case with concomitant necrobiosis lipoidica and splenic abscess. A 58-year-old man presented to emergency center with a two day history of left upper abdominal pain, general malaise, and pyrexia. On both lower legs the patient had skin lesions. The contrast-enhanced computed tomography of the abdomen revealed splenomegaly and splenic abscess in the upper pole of the spleen. On the fourth day after admission, patient underwent open splenectomy. For the lesions on lower legs, by clinical examination, necrobiosis lipoidica was confirmed. The patient was treated by topical administration of steroid cream. After a 2 months follow-up, this treatment was not effective. Left upper abdominal pain and pyrexia in patient with necrobiosis lipoidica may suggest splenic abscess.

Figure 1:

Necrobiosis lipoidica: Yellow-brown skin lesions with indurated borders located on both lower legs.

Figure 2:

The lesion (necrobiosis lipoidica) on the right lower leg located on the pretibial area.

Figure 3:

CECT investigation revealed abscess and air presence in the upper pole of the spleen.