Gangrenous gas necrosis of the spleen: a case report
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Splenic abscess usually arises from hematogenous spread. Causative pathogens are various and anaerobic pathogens are rarely reported.
We report the case of a 50-year-old male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia. Causative pathogens were Clostridium perfringens and Streptococcus gallolyticus. The patient was successfully treated by splenectomy and targeted intravenous antibiotics. No underlying or predisposing disease was found.
Gangrenous necrosis of the spleen is a rare entity that can be successfully treated by splenectomy and antibiotics.
KeywordsSplenic abscess Splenic gangrene Spleen Gangrene Spontaneous gas gangrene
Splenic abscess constitutes an uncommon entity, usually arising from hematogenous spread [1, 2]. Numerous different causative pathogens have been reported in the literature such as Escherichia coli, Proteus mirabilis, Streptococcus spp., Klebsellia pneumoniae, Staphylococcus aureus, Salmonella spp., Enterococcus spp., Pseudomonas spp. [2, 3, 4, 5, 6]. Predominant anaerobic pathogens were reported to be Peptostreptococcus spp., Bacteroides spp., Fusobacterium spp., Clostridium spp. and Propionibacterium acnes [4, 7]. Splenic abscess of fungal origin may arise in immunocompromised patients, such as those with HIV or hematological cancer . Diagnosis is usually made by ultrasonography or computed tomography. Treatment relies either on percutaneous drainage [8, 9] or surgery. However, due to the high failure rate of percuteanous drainage, surgery (splenectomy) often constitutes the definitive treatment for splenic abscesses.
Here, we report the rare case of a spontaneous splenic abscess due to Clostridium perfringens and Streptococcus gallolyticus in an immunocompetent patient.
We report the case of a splenic abscess of polymicrobial origin, due to Clostridium spp and Streptococcus gallolyticus with gas gangrene. The patient was successfully managed by splenectomy and 2 weeks of targeted antibiotic treatment. Clostridium perfringens and Streptococcus gallolyticus were identified from blood cultures, whereas another pathogen, Clostridium baratii was retrieved from the perisplenic liquid. Anaerobic splenic abscesses due to Clostridium perfringens are seldom reported in the literature [4, 7, 11, 12]. In most cases, a predisposing factor exists, as immunodeficiency, hematologic disease, trauma or infectious [12, 13]. Further, spontaneous gas gangrene is mostly due to Clostridium septicum and cases due to Clostridium perfringens are rarely reported [13, 14, 15]. Splenic aneurysm is also a rare complication of infectious diseases, trauma or disorders of the haematopoietic system but could also occur spontaneously [16, 17, 18, 19].
In our case, the patient was immunocompetent, did not have hematologic disease, evidence for endocarditis nor history of trauma whose origin we assume was probably hematogenic.
Bacteriemia due to Clostridium spp. and especially Streptococcus gallolyticus is reported to be associated with gastrointestinal diseases, especially colorectal cancer . Therefore, we performed a colonoscopy, which did not show any signs of colonic neoplasia. Also, bacterial translocation following for example an episode of gastroenteritis is unlikely, as the patient had no diarrhea or vomiting.
In conclusion, we report the case of a splenic abscess of polymicrobial origin, due to Clostridium spp. and Streptococcus gallolyticus with gas gangrene, in an immunocompetent patient without any evidence for endocarditis or trauma. The patient was successfully treated by splenectomy and antibiotics and could be discharged 17 days after admission. Attention should be given to exclude endocarditis, immunosuppression and colonic diseases in such patients.
JM designed the manuscript. JM, AD, BDH, MT and LB wrote the manuscript and contributed to its critical revision. JM, AD, BDH, MT and LB accepted the final version of the manuscript. All authors read and approved the final manuscript.
No funding was received.
Ethics approval and consent to participate
Ethics approval was not required from the local ethics committee. The patient has given his consent to participate.
Consent for publication
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
The authors declare that they have no competing interests.
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