Splenic abscesses as a first manifestation of Crohn’s disease: a case report

Abstract

Background Splenic nodules are uncommon entities that occur rarely in the general population. Although an infectious etiology (primarily bacteria, followed by mycobacteria) is usually found, noninfectious diseases, including malignancies and autoimmune disorders, can also be involved. For instance, in course of inflammatory bowel diseases (IBDs), in particular Crohn’s Disease, aseptic splenic abscesses have been reported in patients with a long history of illness, or in those unresponsive to medical treatments, while are only anecdotally reported in the early phase of the disease. Hence, we presented the case of aseptic splenic nodules as a first manifestation of Crohn’s Disease. Case presentation A 21-year-old woman with a silent medical history was admitted to the Emergency Department of our hospital complaining of fever of 38–39 °C (mainly in the evening) for the past 10 days and left flank abdominal pain, accompanied by sweating and fatigue. An abdominal computed tomography showed multiple splenic nodules of unknown origin. Because of the absence of clinical improvement after several antibiotic therapiesand a positron emission tomography (PET) with hypercaptation strictly localized to spleen, she underwent splenectomy, in suspicion of lymphoma. For persistence of symptoms after splenectomy, she underwent many instrumental examination, including a colonoscopy with bowel and intestinal biopsies that poses diagnosis of Crohn’s disease. A second PET confirmed this diagnosis showing this time also the gastrointestinal involvement. Conclusion An unusual onset of Crohn’s disease with multiple splenic nodules is reported. This case suggests that in light of splenic nodules of unknown etiology attention should be paid to all possible diagnoses of aseptic abscesses, including IBDs (primarily Crohn’s Disease).

Artemisia argyi extract alleviates inflammation in a DSS-induced colitis mouse model and enhances immunomodulatory effects in lymphoid tissues

“…Meanwhile, we also focused on the spleen due to its role in reticuloendothelial system and its versatile functions in immune responses [ 50 ]. Severe IBD sometimes invades the spleen, causing abscesses [ 51 ], while the spleen-associated central immune system may attenuate colitis by promoting CD11b + Gr1 + myeloid cells and activating the cholinergic anti-inflammatory pathway [ 52 , 53 ]. However, the importance and role of both PPs and spleen in IBD have been neglected.…”

Potent CCR3 Receptor Antagonist, SB328437, Suppresses Colonic Eosinophil Chemotaxis and Inflammation in the Winnie Murine Model of Spontaneous Chronic Colitis

“…The organized compartments of the spleen include the red and white pulp regions, separated by the marginal zone [ 98 ]. In IBD pathogenesis, variations in the size of the spleen result in complicated inflammatory processes, leading to high rates of colitis [ 99 , 100 ]. In our study, the reduction in the spleen size in both sham-treated and SB3-treated mice was not accompanied by alterations in the total number of leukocytes compared to the control.…”

Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis

“…Histopathological examinations have shown predominant infiltration of neutrophils around the granulomatous tissue and sterile abscesses. The systemic administration of steroids is the most common induction treatment, and the efficacy of anti-tumor necrosis factor-α (TNF-α) antibody in addition to steroid pulse therapy and immunosuppressants has been recently reported in some refractory cases (Table 2) (1,(6)(7)(8). An AA diagnosis is a diagnosis of exclusion, and there is currently no established diagnostic method.…”

“…To our knowledge, only 43 patients with IBD-associated AAs have been documented and identified using MEDLINE. The features of IBD-associated AAs identified from these reported cases are summarized in Table 2 ( 1 , 6 - 8 ). Our patient is the third Japanese patient reported to have IBD with AAs and the first Japanese patient to have IBD-associated AAs in the spleen, mesenteric lymph nodes, lung, and liver who underwent treatment with splenectomy, GCAP, and IFX.…”