ISOLATED ENTERIC SPLENIC LESION IN AN IMMUNOCOMPETENT HOST: AN INTERESTING CASE REPORT
Splenic abscess is often an unrecognized complication of enteric fever. Diagnosis is difficult because of its rarity, insidious onset, and non-specific presentation. We report an interesting case of splenic lesion in an immunocompetent adolescent with no other comorbidities, who presented with history and clinical presentation more suggestive of tubercular etiology. However, culture from the CT-guided fine-needle aspirate grew Gram-negative bacilli, identified as Salmonella Typhi which was sensitive to ampicillin, cotrimoxazole, azithromycin, and ceftriaxone. He responded favorably with oral antibiotics without any further surgical intervention. High degree of clinical awareness with timely and appropriate microbiological evaluation helped into an early definitive diagnosis of enteric splenic abscess. This case highlights that in this era of emerging infections, we should not miss the atypical presentations of the endemic diseases. Safe and minimally invasive radiological intervention with good microbiological correlation is a successful spleen conserving treatment alternative to surgery in suitable patients of splenic abscess.
2. Divyashree S, Gupta N. Splenic Abscess in immunocompetent patients managed primarily without splenectomy: A series of 7 cases. Perm J 2017;21:16-139.
3. Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, et al. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006;12:460-4.
4. Kizilcan F, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Complications of typhoid fever requiring laparotomy during childhood. J Pediatr Surg 1993;28:1490-3.
5. Phillips GS, Radosevich MD, Lipsett PA. Splenic abscess: Another look at an old disease. Arch Surg 1997;132:1331-5.
6. Nasr B, Chhaider A, Mabrouk MB, Hamida MB, Farhat W, Othmen MB, et al. Diagnosis and treatment of splenic abscess (about 11 cases). J Gastroenterol Hepatol Res 2013;2:786-90.
7. Chiang IS, Lin TJ, Chiang IC, Tsai MS. Splenic abscesses: Review of 29 cases. Kaohsiung J Med Sce 2003;19:501-5.
8. Kumar S, Gupta V, Medappil N, Chandra A. Non-interventional management of splenic abscess. Ann Trop Med Public Health 2014;7:67-9.
9. Ferraioli G, Brunetti E, Gulizia R, Mariani G, MaroneP, Filice C. Management of splenic abscess: Report on 16 cases from a single center. Int J Infect Dis 2009;13:524-30.
10. Kattakayam AJ, Freeman MR, Karakattu SM, Johns SC, Youssef D, Pino P. A case for non-surgical management of splenic abscess in the setting of Salmonella typhimurium bacteremia. J Bacteriol Mycol Open Access 2019;7:64-6.
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