Korean J Gastroenterol.  2018 Oct;72(4):209-212. 10.4166/kjg.2018.72.4.209.

Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated

• Hwang H
• Baeg MK
• Kim P
• Kim YJ
• Kang SH

• KMID: 2424113
• DOI: http://doi.org/10.4166/kjg.2018.72.4.209

Abstract

Splenic abscess is a rare disease that generally occurs in immunocompromised patients. It is difficult to distinguish between splenic abscesses and cysts using imaging studies, especially if they are asymptomatic. A 50-year-old asymptomatic man who had received steroid therapy for underlying rheumatoid arthritis was referred to a university hospital due to presence of several splenic cysts, with the largest being 3.5 cm in diameter. Percutaneous aspiration was performed, and fluid analysis showed cysts infected by extended-spectrum, beta-lactamase-producing Escherichia coli. The patient was treated with ertapenem for four weeks, and the lesion disappeared on follow-up imaging studies. Splenic abscess should be included as a differential diagnosis of splenic cystic lesions in immunocompromised patients.

Keyword

Splenic cyst; Splenic abscess; Arthritis, rheumatoid; Percutaneous drainage

MeSH Terms

Abscess
Arthritis, Rheumatoid
Diagnosis, Differential
Escherichia coli
Follow-Up Studies
Humans
Immunocompromised Host*
Middle Aged
Rare Diseases

Figure

• 

  Fig. 1 APCT and MRI showed that 3.5 cm well-capsulized cystic lesion with internal debris in the spleen (A, B) and multifocal lenticular shaped and cystic changes in the periphery of the spleen (C, D). APCT, abdominal-pelvic computed tomography; MRI, magnetic resonance imaging.

• 

  Fig. 2 APCT after one month's treatment showed nearly complete resolution of previous 3.6 cm cystic lesion in the spleen anterior pole, except a tiny 3 mm sized remnant hypodense lesion (A, arrow) and complete disappearance of peripherally multi-located low attenuation in the spleen (B). APCT, abdominal-pelvic computed tomography.

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