Pathological rupture of spleen in a haemodialysis patient due to tuberculosis

Atraumatic Spleen Rupture in Dialyzed Patients: Clinical Report and Review of the Literature

“…Here, we describe a clinical case of APR in a patient with amyloid light chain (AL) amyloidosis who was on peritoneal dialysis (PD), and we review all clinical cases of dialysis-related APR or ANR indexed in PubMed up to November 2010 without language restriction. In addition to the present case (PC), we found 21 case reports and 1 series of 3 cases, for a total of 24 cases (2-23). We analyzed demographic characteristics, clinical presentation, diagnostic process, and management, focusing on differences between patients on PD and those on hemodialysis (HD).…”

“…Nephroangiosclerosis because of hypertension (2,13,17,18,22) or diabetes (6,11) was the cause of ESRD in 6 patients, renal amyloidosis in 5 (5,9,12,19,PC), chronic glomerulonephritis in 2 (10,20), urolithiasis in 1 (13), lupus nephropathy in 1 (23), and chronic allograft nephropathy in 1 (7 Abdominal pain-either severe from the start, or with dull onset followed by acute precipitation-was experienced by all patients, but only 4 patients (16%), 3 on PD and 1 on HD, presented the pathognomonic Kehr's sign: upper lef t-sided abdominal pain and radiated left shoulder-tip pain resulting from blood irritation of the diaphragm (6,9,13,PC). Median age was 55 years in patients on PD (range: 43 -74 years) and 51 years in those on HD (range: 22 -70 years; p = 0.43); men represented 50% of the patients on PD and 76% of those on HD; and mean time on dialysis was 28 ± 30 months and 40 ± 44 months for patients on PD and HD respectively (p = 0.5).…”

“…The remaining 18 diagnoses (72%) included 2 cases of splenomegaly (15,16), 2 of hemosiderinosis (7,13), 1 of peliosis (20), 1 of myelogenous leukemia (10), 2 of atheroembolic splenic infarcts (6,11), 1 of granulomas of undetermined origin (8), 2 of tubercular granulomas (18,21), and 6 of amyloid deposition, the most common finding (27%) (3[case d], 5,9,12,19,PC). The remaining 18 diagnoses (72%) included 2 cases of splenomegaly (15,16), 2 of hemosiderinosis (7,13), 1 of peliosis (20), 1 of myelogenous leukemia (10), 2 of atheroembolic splenic infarcts (6,11), 1 of granulomas of undetermined origin (8), 2 of tubercular granulomas (18,21), and 6 of amyloid deposition, the most common finding (27%) (3[case d], 5,9,12,19,PC).…”

Spleen Rupture Associated with Septic Emboli and Endocarditis in a Hemodialysis Patient

“…The few previously described cases of non-traumatic pathologic rupture of the spleen in hemodialysis patients were associated with peliosis [21], tuberculosis [22], pancreatitis [23], and infarction due to atherosclerosis [24]. This is the first report of a splenic rupture associated with anaerobic bacteremia and splenic septic emboli in a uremic patient on chronic hemodialysis.…”

Spontaneous Splenic Rupture as a Paradoxical Reaction during Treatment for Splenic Tuberculosis

“…The majority of these cases occurred in immunocompromised patients. These patients had HIV infection3,4,7, longstanding sarcoidosis5, or chronic renal disease requiring hemodialysis6. Thus far, 3 cases have been reported in immunocompetent patients8-10.…”