J Korean Med Sci.  2005 Apr;20(2):313-315. 10.3346/jkms.2005.20.2.313.

Splenic Abscess Associated with Endocarditis in a Patient on Hemodialysis: A Case Report

• Kim HS
• Cho MS
• Hwang SH
• Ma SK
• Kim SW
• Kim NH
• Choi KC

• KMID: 1095210
• DOI: http://doi.org/10.3346/jkms.2005.20.2.313

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 accesssite 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.

Keyword

Spleen; Abscess; Dialysis; Renal Dialysis

MeSH Terms

Abscess/*etiology/pathology/radiography
Aged
Endocarditis, Bacterial/*complications
Humans
Male
Renal Dialysis/*adverse effects
Splenic Diseases/*etiology/pathology/radiography
Tomography, X-Ray Computed

Figure

• 

  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).

Reference

1. Nelken N, Ignatius J, Skinner M, Christensen N. Changing clinical spectrum of splenic abscess. Am J Surg. 1987. 154:27–34.

2. Fonseca V, Baillod R, Berger L, Fernando O, Moorhead J. Splenic abscess in patients on hemodialysis. Am J Kidney Dis. 1990. 15:273–275.

3. Eliting AW. Abscess of spleen. Ann Surg. 1915. 62:182–192.

4. Reid SE, Land SJ. Abscess of the spleen. Am J Surg. 1954. 88:912–917.

5. Chulay JD, Lankerani MR. Splenic abscess. Report of 10 cases and review of the literature. Am J Med. 1976. 61:513–522.

6. Johnson JD, Raff MJ, Barnwell PA, Chun CH. Splenic abscess complicating infectious endocarditis. Arch Intern Med. 1983. 143:906–912.

7. Chuang FR, Lee CH, Chen JB, Cheng YF, Yang BY, Hsu MS, Wu MS. Extra-renal abscess in chronic hemodialysis patients. Ren Fail. 2002. 24:511–521.

8. Nakamura T, Iwashima A, Honma T, Higuma N, Tamura K. Splenic abscess in a patient on hemodialysis. Nephron. 1992. 60:255–256.

9. Kim TY, Rho SY, Son SH, Kim BS, Park JH, Yang CW, Kim YS, Bang BK. A case of liver and spleen abscesses secondary to Yersinia enterocolitica septicemia in a chronic renal failure patient on hemodialysis. Korean J Nephrol. 1999. 18:339–342.

10. Cheesbrough JS, Jones EW, Finch RG. The management of splenic abscess. Q J Med. 1985. 57:653–657.

11. Ting W, Silverman NA, Arzouman DA, Levitsky S. Splenic septic emboli in endocarditis. Circulation. 1990. 82:Suppl IV. S105–S109.

12. Lentino JR, Baddour LM, Wray M, Wong ES, Yu VL. Staphylococcus aureus and other bacteremias in hemodialysis patients: antibiotic therapy and surgical removal of access site. Infection. 2000. 28:355–360.

13. Hosking CS, Atkins RC, Scott DF, Holdsworth SR, Fitzgerald MG, Shelton MJ. Immune and phagocytic function in patients on maintenance dialysis and post-transplantation. Clin Nephrol. 1976. 6:501–505.

14. Parsons FM, Brunner FP, Gurland HJ, Harlen H. Combined report on regular dialysis and transplantation in Europe I. Proc Eur Dial Transplant Assoc. 1971. 8:3.