A Case of Splenic Infarction Caused by Splenic Vein Thrombosis with Paroxysmal Nocturnal Hematuria

Abstract

We report a case of splenic infarction caused by splenic vein thrombosis with paroxysmal nocturnal hematuria (PNH). A 52-year-old man consulted us for subacute left upper abdominal pain on January 16, 1999. He had been admitted to the Depatment of Internal Medicine on January 12, 1999, because of anemia and thrombocytopenia. Before admission he had had attacks of fever on January 2 and January 8 and had taken over-the-counter cold medicine. Ultrasonography and plain CT on January 14 demonstrated slight left pleural effusion and moderate splenomegaly, which had been noticed several years before. The dynamic CT on January 16 revealed that the spleen was not enhanced and the splenic vein could not be traced near the spleen. A splenectomy was performed on January 16 with a preoperative diagnosis of splenic infarction. The spleen, 882g in weight, was infarcted and a partially organized splenic venous thombosis was found at the splenic hilus. The patient had not noticed any hematuria, but the Ham test and the sugar water test, which were performed postoperatively, revealed that the patient was suffering from PNH. Research has shown that thrombosis is a common complication of PNH but, to date in Japan, only a few cases of splenic infarction due to PNH have been reported. We suspect that this case of splenic infarction was caused by PNH.