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      Splenic abscess in cancer chemotherapy

      case-report

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          Abstract

          Background

          Splenic abcess is an uncommon complication for cancer treatment. It occurs more frequently in immunocompromised patients. They are characterized by high mortality. The classic triad (fever, pain of the left hypochondrium, and sensitive mass left) is only present in one-third of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss, abdominal pain left, splenomegaly. Treatment options are limited, but must be discussed and adapted to the patient profile.

          Case presentation

          We report the case of a 62-year-old Arabic male, diagnosed with metastatic lung adenocarcinoma, who, after several cycles of chemotherapy, presented symptoms and signs of splenic abcess.

          Conclusion

          Splenic abcess is rare situation, which must be actively researched, to have access to an optimal therapeutic approach.

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          Most cited references16

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          Evaluation of severe infection and survival after splenectomy.

          Moe Kyaw, Francis Toolis, William Holmes … (2006)
          Splenectomized patients are known to be at risk of severe infection, but the extent of risk is unclear. We evaluated the incidence of severe infection and survival in 1648 splenectomized patients. Patients who underwent splenectomy between 1988 and 1999 in Scotland were identified through the Scottish hospital discharge records (SMR01) and then linked to the death certificate data recorded by the General Register Office in Scotland to obtain clinical and demographical information. The overall rate of first severe infection was 7.0 per 100 person-years (95% confidence interval, 6.30-7.78). The overall rate for a second infection per 100 person-years was 44.9 and 109.3 for a third infection after the first episode of infection. Among the repeated episodes of severe infection, 42% to 76% and 61% to 84% of total episodes of second and third severe infection, respectively, occurred within 6 months after the first severe infection. The susceptibility to severe infection was greatest in older age groups (5.5 per 100 person-years in those aged > 50 years) and in patients splenectomized for hematologic malignancy (9.2), and iatrogenic splenectomy for malignancy disease (7.4). Between 50% and 80% of all severe infections or deaths occurred within 1 to 3 years after splenectomy. The risk of severe infection is an important health problem in splenectomized patients, especially in those who underwent surgery for malignancies. Antibiotic prophylaxis could offer the most benefits in the first 3 years postsplenectomy or the first 6 months after the occurrence of a first severe infection.
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            Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature.

            Abel Ignatius, Randolph N. Christensen, Steve J M Skinner … (1987)
            The changing demographics of splenic abscess in regard to predisposition, clinical setting, diagnosis, bacteriologic findings, and treatment have been presented based on 19 patients from five institutions and 170 patients reported in the literature since 1978. These data, in turn, have been compared with a previously published retrospective review of the world literature from 1900 to 1977. It has become clear that since 1978, splenic abscess is diagnosed earlier in its presentation due to the widespread use of improved imaging techniques, immunocompromised patients comprise a much larger proportion of patients (24 percent) than previously due to increasing use of steroids and chemotherapeutic agents, and the diagnosis of fungal splenic abscess, almost unheard of before 1978, has increased to 26 percent of patients. The diagnostic sensitivity of computerized tomography (96 percent) has clearly been shown to be superior to ultrasonography, and gallium, indium, and technetium-99m liver and spleen scanning. The diagnosis of splenic abscess, however, is still often not considered due to its rarity and the presence of predisposing conditions which obscure its clinical presentation. Untreated splenic abscess is still fatal, and although splenectomy is the mainstay of treatment, it appears that antifungal treatment without splenectomy can be recommended for patients with disseminated fungal disease as long as bacterial abscess has been ruled out by invasive culture techniques. Scattered reports of percutaneous drainage exist and are increasing in the literature, although the results are as yet inconclusive. Eventual recovery depends on early diagnosis and successful treatment of the underlying condition.
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              Splenic abscess: diagnosis and management.

              Koon-Kwan Ng, Tze-Yu Lee, Yung-Liang Wan … (2016)
              To evaluate the usefulness of a combination of computed tomography and sonography for splenic abscess diagnosis and management determination. From January 1986 to June 1999, 30 patients of pyogenic splenic abscess were collected in our hospital. Computed tomograms of the spleen were performed on all of the patients, and abdominal sonographies were performed on 26 of them. The imaging findings of all the patients were reviewed with respect to the clinical presentations, predisposing factors, infective organisms, method of treatment and clinical outcome. The clinical triad of splenic abscess was the main presentation of the 30 patients; it included fever (92%), left upper abdominal pain (77%) and leukocytosis (66%). Infective bacteria were identified in 19 patients, and the most offending bacteria were aerobes (82.6%). The radiological findings included single abscess were found in 16 patients and multiple abscesses were noted in 14 patients. The computed tomography and sonography findings included abnormal gas content (6 cases), progressive enlargement of lesion (6 cases), subcapsular extension of lesion (6 cases), extracapsular fluid collection (8 cases) and cystic lesion (7 cases). 59% of the cases had at least one of the above imaging findings. With the combination of the clinical triad and the imaging findings, the diagnostic rate rose up to 86.7%. Although splenic abscess is rare, it has a high mortality rate if there is delay in diagnosis and treatment. With the combination of computed tomography, sonography and clinical features, early diagnosis and treatment can be made. Percutaneous drainage for single abscess and splenectomy for multiple abscesses are the safe and effective treatment choice. The computed tomography and sonography appearance of splenic abscess is a valuable predictor of outcome of splenic abscess drainage. Medical treatment alone was definitely insufficient.
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                Author and article information

                Contributors
                Essadi Ismail: (+212) 661168987 , ismail_onco@yahoo.fr
                Rachid El Barni: relbarni@gmail.com
                Mohamed Lahkim: medlahkim@yahoo.fr
                Redouane Rokhsi: redrokhsi@yahoo.fr
                Elmehdi Atmane: atelmehdi@yahoo.fr
                Abdelghani El Fikri: abdelghanielf@gmail.com
                Rachid Bouchama: bouchrachid@gmail.com
                Abdessamad Achour: abdesachour@gmail.com
                Mohamed Zyani: medzyani@gamil.com
                Journal
                Journal ID (nlm-ta): BMC Res Notes
                Journal ID (iso-abbrev): BMC Res Notes
                Title: BMC Research Notes
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1756-0500
                Publication date (Electronic): 11 November 2015
                Publication date PMC-release: 11 November 2015
                Publication date Collection: 2015
                Volume: 8
                Electronic Location Identifier: 665
                Affiliations
                [ ]Medical Oncology Unit, IBN SINA Military Hospital, Marrakesh, Morocco
                [ ]General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco
                [ ]Internal Medicine Unit, IBN SINA Military Hospital, Marrakesh, Morocco
                [ ]Radiology Unit, IBN SINA Military Hospital, Marrakesh, Morocco
                Article
                Publisher ID: 1655
                DOI: 10.1186/s13104-015-1655-1
                PMC ID: 4641425
                PubMed ID: 26559779
                SO-VID: f708bb34-4542-405d-8118-b197eb40c7d2
                Copyright © © Ismail et al. 2015
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 12 October 2014
                Date accepted : 2 November 2015
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Medicine
                Keywords: splenic abcess,cancer treatment,complication
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: splenic abcess, cancer treatment, complication

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