Staphylococcus aureus abscess of the spleen in a beta-thalassemia patient

Splenic abscesses are rare among abdominal abscesses. We present a case of splenic abscess due to Staphylococcus aureus in a beta-thalassemia major patient. Such a complication may not be coincidental, as beta-thalassemia major patients have an increased susceptibility to infection, which is attributable to a number of immune abnormalities.     

Splenic abscess in a patient with fecal peritonitis

Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation.The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis.Splenic abscess has a high rate of mortality when it is diagnosed late.Computed tomography resolved any diagnostic doubt,and subsequent surgery confirmed the diagnosis.     

A case of splenic abscess during treatment of interstitial pneumonia

We experienced a case of a 76-year-old man who developed a splenic abscess while undergoing treatment for interstitial pneumonia. Splenic abscess-like abnormal intensities were accidentally found by the chest computed-tomography (CT) examinations 3 weeks after the initiation of corticosteroids and immunosuppressive treatment for interstitial pneumonia. An ultrasonography-guided percutaneous aspiration test resulted in the isolation of methicillin-resistant Staphylococcus aureus (MRSA). Since colonized MRSA had been detected intermittently from sputum after admission and the patient risked bloodstream infection from an indwelling central venous catheter and intubation, we suspected that the organism colonized in the airway had spread into the bloodstream via these devices. Although CT-guided percutaneous drainage followed by postoperative antibiotic therapy are normally required for the treatment of splenic abscess, the patient was successfully treated by the administration of vancomycin without drainage.     

Primary psoas abscess due to Fusobacterium nucleatum.

A case of primary pyogenic psoas abscess due to Fusobacterium nucleatum is described. Clinicians must maintain a high index of clinical suspicion for the diagnosis of psoas abscess. Although Staphylococcus aureus accounts for most cases of primary psoas abscess, this report emphasizes the importance of bacteriological confirmation of the microorganism involved.     

Intra-abdominal abscess as presentation of colonic cancer

Splenic abscess and retroperitoneal abscess are uncommon, although severe diseases, with a high mortality rate that has been attributed to delayed diagnosis, due to the unspecificity of clinical symptoms. We report two patients with a splenic and a retroperitoneal abscess, respectively, in both cases as an onset of colon cancer. The two patients complained of abdominal pain and fever as onset symptoms. Abdominal ultrasonography was normal in the case of retroperitoneal abscess and abnormal in the case of splenic abscess. CT Scan was diagnostic in both cases. In the patient with splenic abscess. CT Scan established a further diagnostic suspect of colon cancer, which was confirmed by colonoscopy. In the patient with retroperitoneal abscess, diagnosis of colon carcinoma was made during the surgical act. In spite of an adequate, combined medical and surgical therapy, both patients died within a short time after surgery.     

Peritonitis secondary to ruptured splenic abscess: A grave complication of typhoid fever

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.     

An Unusual Pathogen for a Liver Abscess in a Human Immunodeficiency Virus-Infected Individual

Pyogenic liver abscesses are rarely encountered in HIV-infected patients living outside of temperate climates and are usually polymicrobial in nature, with a majority of the pathogens arising from gastrointestinal flora. We describe the second case of a liver abscess in an HIV-positive individual that was caused by methicillin-resistant Staphylococcus aureus (MRSA), most likely due to a partially treated community-acquired MRSA skin abscess. The liver abscess was successfully managed by percutaneous drainage and intravenous antibiotics. This case underlines the ubiquitous nature of community-acquired MRSA and its possible unusual presentations in immunocompromised hosts.     

Pyogenic splenic abscesses. A review of 8 cases

PURPOSE: Pyogenic splenic abscess is un uncommon and potentially life-threatening disease. Due to inconspicuous and nonspecific clinical picture, it remains a diagnostic challenge. Medical imaging progresses are helpful for diagnosis and treatment. METHODS: We tried to establish epidemiologic and clinical features and therapeutic possibilities of 8 cases of splenic abscesses occurred between 1993 and 2002. RESULTS: There were 5 male patients and 3 female patients. Aged ranged from 17 to 53 years, with a median of 34 years. One patient was immunocompromised (colonic carcinoma). Common clinical presentations included fever (n=8) and left upper quadrant abdominal pain (n=7). Positive blood cultures were found in only four patients (50%) : Staphylococcus aureus (3) and coagulase negative Staphylococcus (1). Staphylococcus aureus and Bactero?des fragilis were isolated in one abscess pus respectively. The diagnosis was obtained by ultrasonography in all 8 cases. Antibiotics were prescribed in all cases for a mean length of 60 days (30 - 110 days). Splenectomy and percutaneous CT-guided drainage were performed in one case respectively. Evolution was good in all cases. CONCLUSION: Splenic abscesses are increasingly recognized. The combination of clinical features and imaging findings, early diagnosis and treatment can be made.     

Bacteroides (Parabacteroides) distasonis splenic abscess in a sickle cell patient

Splenic abscess is not an uncommon complication of patients with sickle-cell disease. Here we describe an 18 year-old boy with sickle cell disease and left upper quadrant abdominal pain. Computerized axial tomography revealed left sided free flowing pleural effusion and splenomegaly with liquefaction and possible gas formation. The splenic fluid grew an unusual organism known as Bacteroides distasonis. The patient received antimicrobial therapy and underwent a splenectomy with full recovery. The spleen was cystically infarcted and measured 22 x 16 x 5 cm. The capsule was thickened and covered by fibrinous exudate. Histopathologic examination of the spleen showed complete necrosis with reparative fibrosis. This case presents an unusual cause of splenic abscess due to Bacteroides distasonis with a subacute to chronic course. The presence of fever and left sided pleuritic chest pain in patients with sickle cell disease should raise the suspicion of splenic abscess.     

Abcès de la rate : du diagnostic au traitement

Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50?80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.     

Splenic involvement in infectious endocarditis. 5 clinical cases and 78 necropsies

Splenic involvement is a classical complication of infective endocarditis (IE). Clinical manifestations are rare, 5 out of 100 IE: unexpected rupture (1 case), abscess causing reinfection (2 cases), pseudo-tumour (1 case) and terminal infarction (1 case). In addition to a review of the literature, a post mortem histological study of the spleen of 78 cases of IE was undertaken. Splenic involvement did not seem to be the direct cause of death. Three types of lesions which may or may not be associated were observed: congestive inflammatory lesions, infarction (48 p. 100), abscess (6 p. 100). Splenic infarction usually results in scarring but may progress to abscess formation. Rupture was not observed in this autopsy series. Although splenic involvement is common at post mortem it gives rise to few symptoms. Persistant pyrexia and the appearance of local signs should lead to investigation of splenic complications and eventually, to surgical ablation.     

Primary chest wall abscess caused by Escherichia coli costochondritis

Chest wall abscess may occur as primary infection or secondary to open trauma or thoracic wall surgery. The authors describe an unusual case of Escherichia coli costochondritis occurring 2 months after a blunt chest wall trauma. Primary chest wall abscess due to E coli costochondritis has been previously reported only twice occurring after urinary tract infection. All other very few reports of E coli costochondritis have been reported only after thoracic surgical procedures. An English literature review of primary chest wall abscess showed that 4 pathogens are responsible for the majority of cases: Actinomyces, Staphylococcus aureus, Candida albicans and Salmonella. C albicans costochondritis was most commonly reported among heroin addicts. The appearance of a growing chest wall mass should always prompt a search for an infectious cause, even with little or no systemic signs and symptoms.     

Splenic abscesses: review of 29 cases

Splenic abscess is an unusual and potentially life-threatening disease. Due to the nonspecific clinical picture, it remains a diagnostic challenge. Splenic abscess should be suspected in febrile patients with left upper quadrant tenderness and leukocytosis, and diagnosis confirmed based mostly on imaging studies, microbiologic and / or pathologic evidence, or by response to antibiotic or antifungal treatment. We present 29 cases of splenic abscess treated in our hospital from 1990 to 2001. There were 18 male patients (62%) and 11 female patients (38%). Ages ranged from 4 to 85 years, with a median of 44 years. There were five pediatric patients (17%) and 24 adults (83%). The most common associated condition was leukemia. Most patients were immunocompromised (72%). The more common signs and symptoms were fever (90%), chills (41%), abdominal pain (31%), and leukocytosis (38%). Ultrasonography of the abdominal cavity was positive in 27 cases (93%); computerized tomography or magnetic resonance imaging was used in 26 patients (90%) and was positive in all patients. The abscess was solitary in 21 cases (72%) and multiple in eight cases (28%). Positive blood cultures were found in only seven patients (24%). According to the literature, the treatment of choice is still splenectomy, but in our study, the success rate of 75% with antibiotics alone indicates that antibiotic therapy should be considered an important alternative treatment modality in patients not suitable for percutaneous drainage and splenectomy.     

Prostatic abscess due to community-acquired methicillin-resistant Staphylococcus aureus

We report what we believe to be the second case of a prostatic abscess due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). A previously healthy diabetic man presented with dysuria, fatigue, weight loss, a tender prostate, and leukocytosis. Computerized tomography of the abdomen and pelvis demonstrated a large prostatic abscess at the base of the bladder. Blood, urine, and pus obtained by percutaneous aspiration grew MRSA. Percutaneous drainage and prolonged therapy with intravenous vancomycin resulted in cure. Prostatic abscess is most often caused by Gram-negative organisms. Community-acquired MRSA, which usually causes skin and soft tissue infections, may also cause prostatic abscess. The mainstay of treatment of prostatic abscess is drainage, which can be accomplished either percutaneously or transurethrally. Gram stain and culture of the drainage will direct proper antibiotic selection.     

Aortic periprosthetic abscess with extension to both atria

The periprosthetic abscess due to infective endocarditis constitutes a severe complication of an aortic valve replacement, causing high mortality, despite combined medical and surgical treatment, especially in "early" endocarditis. Transthoracic echocardiography, and especially transesophageal study, is the election procedure for a non invasive diagnosis of vegetation and local complications. We report the aggressive and fulminant case of a 43 year old woman with aortic periprosthetic abscess and the extension to both auricles, due to Staphylococcus epidermidis.     

Psoas abscess due to Pasteurella multocida

Psoas abscess is a pus collection within the muscle compartment. It is a very uncommon entity. It can be primary as a result of haematogenous spread or secondary as a consequence of a direct extension of an infectious focus. Diagnosis is usually delayed because nonspecific clinical presentation. Staphylococcus aureus is the most common organism cultured in this type of abscess. We describe a secondary psoas abscess in an elderly female patient. The patient presented with fever, right groin pain and malaise. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a psoas abscess due to Pasteurella multocida, which is a Gram negative bacteria, part of the normal oral flora of many animals and can causes human infections after animal scratches or bites. More rarely is to find this organism causing psoas abscesses. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge and a high index of suspicion is required. We emphasize the importance of bacteriological confirmation of microorganism involved to choose the correct antibiotics. Percutaneous drainage is the treatment of choice. Open surgical drainage should be reserved if percutaneous drainage fails.     

Splenic sepsis in sickle cell disease

We describe two patients with sickle cell disease (SCD) who developed infections situated in the spleen. One patient had a splenic abscess and there was strong clinical evidence for an infected splenic infarct in the second patient. SCD predisposes to splenic infection because of functional hyposplenism, defective phagocyte function and splenic infarction. Splenic infections can occur in patients who might be considered to have an absent spleen and the diagnosis of splenic abscess should be considered in individuals with SCD who present with fever and abdominal pain.     

Splenic Abscess: A Diagnostic Challenge

Splenic abscess is uncommon and remains a diagnostic challenge. We present two cases. Both patients had predisposing factors that may have led to the splenic abscess. At admission, both patients presented clinical and roentgenographic signs, suggestive but nonspecific for splenic suppuration. Of particular interest was the isolation of Salmonella typhimurium in our first patient. The literature on splenic abscess is reviewed.     

Intramedullary spinal cord abscess associated with cervical spondylodiskitis and epidural abscess

A 50-year-old man presented a cervical vertebral osteomyelitis and epidural abscess due to Staphylococcus aureus. There were significant changes in the cervical region, as revealed by CT scan and MRI, leading to the diagnosis of associated intramedullary abscess of the spinal cord, which was confirmed by anatomopathological study.     

Brain abscess caused by Brucella abortus and staphylococcus aureus in a child

Summary A case of a 12-year-old male with Fallot's tetralogy and brain abscess due to Brucella and Staphylococcus is presented. The abscess was aspirated andBrucella abortus andStaphylococcus aureus were isolated.

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Hirnabszess durch Brucella abortus und Staphylococcus aureus

Zusammenfassung Ein 12jähriger Junge mit Fallot'scher Tetralogie und Hirnabszess, verursacht durch Brucella und Staphylokokken, wird vorgestellt. Der Abszess wurde punktiert und aus dem Aspirat wurdenBrucella abortus undStaphylococcus aureus isoliert.