Spontaneous splenic rupture precipitated by cough: A case report and a review of the literature

Spontaneous rupture of a normal spleen without a history of trauma is a rare clinical entity. We report on a case of atraumatic splenic rupture in a 61-year-old man who presented to the emergency department for abdominal pain and hypotension. There was no evidence of hematologic or infectious disease involving the spleen. The chronic cough described by the patient was the main trigger for the rupture. Although, spontaneous splenic rupture is rare, it is vital that physicians consider this diagnosis when evaluating patients with abdominal pain and hypotension. Failure to consider splenic rupture could be catastrophic and early diagnosis is essential for a better outcome.     

Spontaneous splenic rupture precipitated by cough: a case report and a review of the literature

Spontaneous rupture of a normal spleen without a history of trauma is a rare clinical entity. We report on a case of atraumatic splenic rupture in a 61-year-old man who presented to the emergency department for abdominal pain and hypotension. There was no evidence of hematologic or infectious disease involving the spleen. The chronic cough described by the patient was the main trigger for the rupture. Although, spontaneous splenic rupture is rare, it is vital that physicians consider this diagnosis when evaluating patients with abdominal pain and hypotension. Failure to consider splenic rupture could be catastrophic and early diagnosis is essential for a better outcome.     

Atraumatic splenic rupture: an unusual manifestation of acute HIV infection

A 27-year-old white male, who had sex with other men, presented to the emergency department with 3 days of left shoulder and abdominal pain. He reported no history of trauma to the abdomen. On abdominal imaging, he was found to have hemoperitoneum from a ruptured spleen; he underwent splenectomy. Causes of atraumatic splenic rupture can be divided into six main categories: infectious, neoplastic, inflammatory, congenital or structural, iatrogenic, and idiopathic. Work-up of the atraumatic splenic rupture revealed that his HIV antibody was newly positive. He had a documented negative HIV antibody 3 weeks prior to the current admission. CD4 cell count, obtained after splenectomy, was 904 cells per microliter and the HIV-1 plasma RNA level was 4657 copies per milliliter. Spleen pathology demonstrated an enlarged spleen with increase in the number of small to intermediate size lymphoid cells in the red pulp, and reactive follicular lymphoid hyperplasia, with numerous secondary lymphoid follicles and reactive germinal centers in the white pulp. T-cell receptor (TCR) gene rearrangement studies demonstrated a positive TCR beta gene rearrangement, without a TCR gamma gene rearrangement, consistent with a clonal CD8(+) T-cell population. The case gives rare insight into what happens in the spleen during acute HIV infection and encourages HIV testing in those presenting with atraumatic splenic rupture. Counseling patients with acute HIV to avoid potential trauma should also be considered.     

Spontaneous splenic rupture during induction chemotherapy for acute promyelocytic leukemia successfully treated with splenectomy

We report a case of acute promyelocytic leukemia who suffered spontaneous splenic rupture with massive hemoperitoneum while receiving intensive induction chemotherapy. Emergency computed tomography of the abdomen helped in the diagnosis of intra-abdominal bleeding. The patient was successfully treated with immediate splenectomy and made an uneventful postoperative recovery. Ten days after surgery chemotherapy could be resumed and complete remission was achieved. Although spontaneous splenic rupture is a rare complication of hematologic malignancies, this diagnosis should be considered in all patients with leukemia who develop acute abdominal pain with hypotension, even in the absence of splenomegaly.     

Ungewöhnliche Komplikation eines akuten Schubs bei chronischer Pankreatitis

Atraumatic rupture of the spleen is a rare, but life-threatening complication of pancreatitis. We report a case of an atraumatic spleenic rupture in chronic pancreatitis. A 41 year old man presented in the emergency room with abdominal pain and typical signs of acute pancreatitis. His medical history showed a chronic pancreatitis due to alcoholism with recurrent acute pancreatitic episodes. He denied any trauma in the recent past. In the next few hours he showed clinical signs of a severe hemorrhagic shock. The haemoglobin level fell from 9.4 to 3.0 g/dl. Abdominal ultrasound and abdominal CT scan showed free fluid. In the following laparotomy a splenectomy was performed due to splenic rupture. A histological examination of the spleen revealed no reason, that could explain the splenic rupture. Hence we assumed a spontaneous rupture. The reported case demonstrates that in acute pancreatitis and signs of shock it is necessary to rule out rupture of the spleen e.g. via ultrasound and abdominal CT scan. If there are signs of spleenic rupture, the only therapy of this life-threatening complication is instant operation to save patient's life.     

Rectus Sheath Hematoma Mimicking Acute Splenic Disease

In patients with hematological malignancies and splenomegaly, acute abdominal pain in the left upper quadrant is highly suspicious of splenic disease (i.e., hematoma, infarction, or rupture). We report the case of a patient with chronic myelogenous leukemia and splenomegaly who presented an unusual abdominal condition causing pain in the left upper quadrant, with a clinical presentation mimicking acute splenic disease. The diagnostic dilemma was resolved by ultrasonography, demonstrating a rectus sheath hematoma.     

Fatal rupture of the spleen caused by infiltration of T-cell lymphoma

 Pathological or spontaneous rupture of the spleen has been described in a variety of diseases affecting the spleen, with infections being cited as the cause in most cases. In hematological malignancies it is a rare event, despite the frequent involvement of the spleen in these diseases. It has, however, been described in patients with acute and chronic leukemia, Hodgkin's disease, non-Hodgkin's lymphoma of B-cell origin, mycosis fungoides, and so-called histiocytic lymphoma. Here, we present a fatal case of splenic rupture caused by infiltration of a peripheral T-cell lymphoma, unspecified according to the REAL classification. The importance of a correct diagnosis and fast surgery is emphasized. Received: April 8, 1999 / Accepted: July 20, 1999     

Spontaneous splenic rupture in two patients with a blastoid variant of mantle cell lymphoma

 Spontaneous rupture of the spleen is a rare complication of hematological malignancies, occurring most commonly in patients with acute leukemia, but it has been documented in chronic leukemias and also in lymphomas. We report two patients with histologically and immunohistochemically confirmed mantle cell lymphoma (MCL) who experienced a spontaneous splenic rupture. An 80-year-old woman and a 51-year-old man had a blastoid variant of MCL and responded poorly to conventional treatment. Both patients recovered after splenectomy. The woman died of progressive lymphoma 2 months later. An allogeneic bone marrow transplantation was performed in the man with a good initial result, but an aggressive relapse was seen only 6 months later and he died of progressive lymphoma. In view of our data, we suggest special caution when MCL is complicated by rapid progression and severe splenomegaly. Although it is a rare phenomenon, the risk of splenic rupture should be kept in mind. Received: 2 September 1996 / Accepted: 16 October 1996     

Spontaneous splenic rupture as the initial manifestation of acute lymphoblastic leukaemia: Immunophenotype and cytogenetics

Summary Spontaneous splenic rupture is a rare, though life-threatening complication of some hematological malignancies and is even more infrequent as the initial symptom of acute lymphoblastic leukemia. We describe the fourth case, to our knowledge, of acute lymphoblastic leukemia presenting as splenic rupture, and for the first time the immunophenotype and cytogenetic pattern observed.     

Spontaneous remission of acute monocytic leukemia after infection with Clostridium septicum

Spontaneous remissions of acute myeloid leukemia (AML) have been reported in association with infection. Here, we report a case of spontaneous remission of AML in a 47-year-old Saudi Arabian male patient who presented with a few weeks history of recurrent abdominal pain, vomiting and fever. He was diagnosed with acute monocytic leukemia (AML, FAB M5b) and a perforated bowel. He also had Clostridium septicum bacteremia and thus chemotherapy was deferred. He received supportive therapy and intravenous antibiotics. Six weeks later, he achieved spontaneous and complete remission lasting for about 4 months. The remission and relapse were documented by bone marrow examination. Similarly, previous reports of spontaneous remission of AML were short lived and were followed by relapse and progression.     

Fatal splenic rupture caused by infiltration of adult T cell leukemia cells

The spleen is an immunological organ commonly involved in both hematological and nonhematological diseases. Pathological rupture of the spleen has been described in a variety of diseases affecting the spleen. Infections have been cited in most cases involving splenic rupture, but are rare in hematological malignancies despite frequent involvement of the spleen. The present report describes a fatal case of splenic rupture caused by infiltration of adult T cell leukemia cells and reports the mechanism of splenic rupture. The importance of rapid diagnosis and surgery is emphasized.     

Spontaneous splenic rupture during intrasplenic Kaposi's sarcoma in an HIV-positive patient

Spontaneous splenic rupture is a rare cause of peritoneal bleeding. Etiology is usually infections (viral, bacterial or parasitic) and blood diseases (leukemia, lymphoma, dysglobulinemia). We report the first case of spontaneous splenic rupture secondary to hilar Kaposi's sarcoma in an HIV positive patient. Emergency splenectomy was performed to achieve hemostasis, and the etiological diagnosis of this spontaneous splenic rupture was based on the histological analysis.     

Safety of imatinib in chronic myeloid leukemia in blastic crisis presenting as cholestatic jaundice

Acute leukemia presenting as cholestatic jaundice is rare. It can occur due to granulocytic sarcoma compressing the bile ducts in case of acute myeloid leukemia. Rarely, diffuse infiltration of the liver sinusoids by the leukemic blasts can present as cholestatic jaundice. We report a case of chronic myeloid leukemia in lymphoid blast cell crisis presenting with severe cholestatic jaundice due to diffuse infiltration of the liver sinusoids with lymphoblasts. This patient tolerated imatinib well and, coinciding with the hematological response, there was marked reduction in the cholestasis due to blast clearance from the hepatic sinusoids. He was subsequently treated with combination chemotherapy and achieved morphological and cytogenetic remission.     

Splenic rupture in a patient with acute myeloid leukemia undergoing peripheral blood stem cell transplantation

 Splenic rupture is a rare but well-recognized complication of hematological malignancies. Here, we present the case of a 22-year-old woman with the diagnosis of acute myeloid leukemia who was undergoing peripheral blood stem cell transplantation. On day +10 she developed a hypovolemic shock due to rupture of her spleen and went to emergency laparotomy. This is the first report of splenic rupture during peripheral blood stem cell transplantation. Received: May 7, 1998 / Accepted: October 21, 1998     

Spontaneous rupture of the spleen associated with Legionella pneumonia

Spontaneous rupture of the spleen associated with Legionella pneumonia is a rare and life-threatening complication; only three cases have been reported to date. The authors describe a case of a 47-year-old man who presented with pneumonia and abdominal pain. He underwent a splenectomy, and was successfully treated with clarithromycin and levofloxacin.     

A rare case： Spontaneous cutaneous fistula of infected splenic hydatid cyst

Hydatid disease is caused by the larval stage of the genus Echinococcus. Live hydatid cysts can rupture into physiologic channels,free body cavities or adjacent organs. Although hydatid disease can develop anywhere in the human body, the liver is the most frequently involved organ, followed by the lungs. Cysts of the spleen are unusual. There are only five case reports of spontaneous cutaneous fistulization of liver hydatid cysts in the literature. But there isn't any report about cutaneous fistula caused by splenic hydatid cyst. We report a first case of spontaneous cutaneous fistula of infected splenic hydatid cyst. A 43-year-old man was admitted to our Emergency Service with abdominal pain and fluid drainage from the abdominal wall. He has been suffering from a reddish swelling on the abdominal wall skin for four months. After a white membrane had been protruded out from his abdominal wall, he was admitted to our Emergency Service. On physical examination, a white membrane was seen to protrude out from the 2cm×1cm skin defect on the left superolateral site of the umblicus. Large, complex, cystic and solid mass of 9.5 cm-diameter was located in the spleen on ultrasonographic examination. At operation, partial cystectomy and drainage was performed. After the operation, he was given a dosage of 10 mg/kg per day of albendazole, divided into three doses. He was discharged on the postoperative 10th d. It should be kept in mind that splenic hydatid cysts can cause such a rare complication.     

Spontaneous Rupture of the Spleen

Crohn's disease is associated with many local complications. Spontaneous rupture of the spleen secondary to Crohn's colitis with a fistulous tract into the adjacent fixed spleen has never been reported in the literature. A case report and a brief review of spontaneous splenic rupture and colonic perforation in Crohn's disease is presented.     

Acute abdomen caused by spontaneous rupture of splenic hydatid cyst

We report a rare case of acute abdomen caused by the spontaneous rupture of a splenic hydatid cyst into the abdominal cavity, causing a massive hemoperitoneum due to accompanying rupture of the spleen which required splenectomy. A review is made of the literature on this rare entity, its treatment and its consequences and their prevention and treatment.     

CD7+ and CD56+ myeloid/natural killer cell precursor acute leukemia treated with idarubicin and cytosine arabinoside

We describe a 69-year-old Japanese male with acute leukemia with a CD7+ and CD56+ immunophenotype presenting with multiple lymphadenopathy. He was treated with idarubicin and cytosine arabinoside. Although the leukemia showed partial response, the patient did not achieve complete remission. He died of sepsis due to severe neutropenia after the third course of chemotherapy. His autopsy revealed blast infiltration in the lymph nodes, liver, spleen and vertebral bone marrow. Recently, CD7+ and CD56+ myeloid/natural killer precursor acute leukemia has been associated with a poor prognosis. Our case illustrates that myeloid/natural killer cell precursor acute leukemia shows some response to intensive chemotherapy for acute myeloid leukemia, but such therapy is insufficient to effect a cure. To overcome the resistance of this disease to chemotherapy, further studies should explore other treatment strategies.     

Pathologic rupture of the spleen in hematologic malignancies: two additional cases

 Pathologic rupture of the spleen in hematologic malignancies is rare. We present two cases of splenic rupture which occurred in a man with a secondary high-grade non-Hodgkin's lymphoma and a woman with chronic lymphocytic leukemia (CLL). In a review of the literature, we have been able to identify 136 cases of pathologic splenic rupture since 1861; 34% have occurred in acute leukemias, 34% in non-Hodgkin's lymphomas, and 18% in chronic myelogenous leukemia (CML). We find a male-to-female ratio of 3 : 1, with considerable differences for the specific diseases encountered. Pathologic rupture of the spleen has happened almost exclusively in adults and the ruptured spleens are generally moderately to severely enlarged. It seems that, apart from splenic infiltration by a hematologic disease, splenic infarcts and coagulation disorders (which have previously been advanced as the most important pathophysiologic factors leading to rupture), male sex, adulthood, severe splenomegaly, and cytoreductive chemotherapy may increase the risk for pathologic splenic rupture. We briefly discuss symptoms preceding the event, diagnostic possibilities, and the outcome with operative and conservative approaches. Received: 24 July 1996 / Accepted: 30 September 1996