Splenic Abscess

Aka: Splenic Abscess, Spleen Abscess

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II. Causes

  1. Bacteremia including Endocarditis
    1. Staphylococcus Aureus
    2. Streptococcus
    3. Bartonella (Cat Scratch Disease)
  2. Contiguous spread from intra-abdominal infection or peritonitis
    1. Polymicrobial infections
  3. Immunocompromised patients
    1. Candida (Candidemia)
  4. Other causes seen in Southeast Asia
    1. Klebsiella
    2. Burkholderia pseudomallei

III. Symptoms

  1. Fever
  2. Left Upper Quadrant Abdominal Pain

IV. Labs

  1. Complete Blood Count
    1. Leukocytosis

V. Imaging

  1. CT Abdomen and Pelvis

VI. Differential Diagnosis

  1. Splenic Infarction (CT findings are similar)

VII. Management

  1. Surgery Consultation for possible Splenectomy
    1. May also consider percutaneous abscess aspiration in high risk surgical patients
  2. Empiric Antibiotic selection depends on suspected source
    1. Bacteremia including Endocarditis (Streptococcus, Staphylococcus)
      1. Vancomycin if MRSA suspected (or e.g. Nafcillin if MSSA)
    2. Contiguous spread from intra-abdominal infection or peritonitis (Polymicrobial infections)
      1. Piperacillin-Tazobactam (Zosyn)
    3. Immunocompromised patients (Candidiasis)
      1. Fluconazole or Caspofungin or Amphoteracin B

VIII. Prognosis

  1. Mortality approaches 70% in delayed diagnosis and 80% in Immunocompromised patients

IX. Resourves

  1. Splenic Abscess (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK519546/

X. References

  1. (2019) Sanford Guide, accessed on IOS 2/3/2020
  2. Lee (2018) Can J Infect Dis Med Microbiol +PMID: 29666665 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830950/

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