A case of splenic abscess probably caused by splenic infarction due to infectious endocarditis

Abstract

A 50-year-old man was seen at the hospital because of high fever and abdominal pain. There were tenderness in the entire abdomen and he had inflammatory reaction and diabetes. Abdominal CT and ultrasonic examinations revealed a cystic lesion in the spleen, and splenic abscess was diagnosed. Despite administration of antibiotics, no symptomatic remission was gained and percutaneous drainage was started on the third hospital day. A bacteriological examination of ash-colored purulent aspirated fluid about 1500 ml yielded Streptococcus sanguinis oralis, an oral microorganism. On the 32 nd hospital day, his high fever and respiratory and circulatory conditions took downhill course. Accordingly prolonged septicemia was diagnosed and splenectomy was performed on the 38 th hospital day. Pathological studies showed findings of splenic infarction due to bacterial mass. Echocardiography under suspicion of infectious endocarditis demonstrated a verruca at the anterior cusp of the mitral valve and serious mitral insuffciensy. Cardiac failure caused by these conditions was thus diagnosed. The patient was transferred to another hospital and underwent mitral valve replacement 14 days after the splenectomy.
We reported a case of splenic abscess with splenic infarction caused by infectious endocarditis due to an oral microorganism.