Baylor University Medical Center Proceedings April 2017 - 174

resulting in massive cardiomegaly and atrial ﬁbrillation requiring
atrial ablation with subsequent infectious complications.
DISCUSSION
These patients both died from bacterial sepsis associated with
unrecognized splenic abscesses, and abdominal imaging, such
as computed tomography or ultrasound, was not performed
on either patient. The rarity of this complication, along with
the diﬃculty in diagnosis, requires a high index of suspicion
in patients with sepsis that is refractory to antibiotic therapy.
However, the classic triad of fever, leukocytosis, and left upper
quadrant abdominal pain is not present in many cases. The
most sensitive signs are fever (90%) and leukocytosis (88%);
however, these are obviously nonspeciﬁc (4). Furthermore, both
patients had multiple negative blood cultures after the initial
positive culture, but despite aggressive antibiotic therapy, neither improved. In general, patients with infective endocarditis
or other forms of severe bacterial sepsis with abdominal pain or
swelling or with prolonged fever despite appropriate antibiotic
therapy should be considered for abdominal imaging in search
of a splenic abscess (5).
After diagnosis of a splenic abscess, standard therapy has
included immediate splenectomy (2). However, recent studies
have found some success with percutaneous ultrasound-guided

174

drainage, followed by splenectomy in patients who did not
improve, and the reported rates of successful drainage procedures ranged from 17% to 100% (4, 6, 7). Furthermore, some
of these patients had multiple splenic abscesses that were successfully treated by multiple separate drainage procedures (6).
However, in view of the dire consequences of inadequate therapy
for splenic abscess, further studies are needed to clarify which
patients may be safely managed without splenectomy.
1.
2.

3.
4.
5.

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