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

Abstract

We present an uremic patient on chronic hemodialysis with splenic septic emboli associated with active infective endocarditis and anaerobic bacteremia complicated by ruptured spleen. A 62-year-old female patient was admitted because of fever and pain in the left upper abdomen and swelling and hematoma around the left brachiocephalic arteriovenous fistula. Transthoracic echocardiography revealed mobile hyperechoic mass (vegetation) on the anterior mitral valve. Abdominal ultrasound scan showed multiple hypoechoic lesions of the enlarged spleen, described as possible necroses or abscesses, and computed tomography showed low-density inhomogeneous lesions in the enlarged spleen with large perisplenic hematoma, with spleen rupture. Blood culture revealed anaerobic Gram-negative bacilli (Bacteroides spp.), ampicillin resistant. This is the first report of splenic rupture associated with anaerobic bacteremia and splenic septic emboli in a uremic patient on chronic hemodialysis. Splenic septic emboli with abscess/infarction in hemodialysis patients are a rare disorder but could be a consequence of dialysis access site infection and might predispose to splenic rupture. Ultrasound scan of abdomen is fast, inexpensive and easy to perform. As mortality is high, early surgical intervention on vascular access is mandatory.

Non-traumatic ruptured splenic abscess presenting with pneumoperitoneum in an immunocompetent patient: a diagnostic dilemma

“…Splenic abscess is an uncommon and life-threatening condition with an incidence of 0.14%–0.7% in some series 1–3. However, recent literature demonstrate that splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities, and increasing prevalence of immunodeficiency state like AIDS.…”

“…The reported mortality rate of this condition in different series vary from 0% to 47% 1. Presentation of the splenic abscess is often vague and insidious including left upper quadrant abdominal pain, fever and chills 2. Additionally, these patients may present with leucocytosis, left upper quadrant mass and pleural effusion on chest X-ray.…”

Atraumatic splenic rupture secondary to abscess in a hemodialysis patient: a rare and fatal cause of acute abdomen diagnosed late

“…Aerobic microorganisms are the most common infectious agents, particularly staphylococci, streptococci, Escherichia coli and salmonella. In addition, it emerged as a major risk factor for immunosuppression, hemoglobinopathy and DM [ 4 ].…”

Pathological rupture of the normal spleen: Review with the literature

“…In this compilation, only 2 (1.4%) spleens were found to have a normal weight. Cases of splenic rupture are available in the literature on infective endocarditis and septic embolism [13] , [14] . Splenic rupture is acute abdominal pathology with complicated etiology.…”