Arshad Naseem.
Splenic Abscess - Secondary To Brucella Melitensis.
J Coll Physicians Surg Pak Jan ;12(8):488-90.

Splenic abscess is a rare occurrence in immunocompetent patients. It has varied etiology, poorly specified clinical presentations and often fatal natural outcome. Among different infections, Brucellosis can lead to visceral abscesses but an isolated splenic abscess is extremely uncommon. A case of a young and healthy male patient with such abscess is presented here, who had relapsing fever for eight weeks. On ultrasonography, an abscess in spleen was identified, while anti-Brucella agglutination test was positive for Brucella Melitensis. The patient responded to anti-brucella antibiotics without percutaneous drainage.

Case Report: A 20 years old patient, soldier by profession, was admitted to the medical ward of CMH, Murree on 16th of December 1999 with eight week`s history of relapsing fever. On further interrogation it was revealed that he was admitted in the same ward in the last week of October for similar complaints of one week duration. At that time he was febrile and anorexic having body aches with headache and discomfort in left lower part of chest. There was no history of cough, diarrhoea, skin rash, joint swellings, burning micturition, and palpitations. Fever was relapsing accompanied with chills, sweating and myalgias. Clinically, he was febrile 101oF with pulse 90 per minute and B.P 110/70 mmHg. Splenic tip was just palpable in right lateral position. It was soft, smooth and had regular edge. There was no skin rash, lymphadenopathy, jaundice, pallor, edema or clubbing. His cardiovascular, respiratory and neurological clinical assessment was unremarkable. His blood complete picture, urine routine examination, x-ray chest, blood for malarial parasite, Widal test, and blood culture were normal. For initial three days he was managed with capsule Amoxicillin 500mg 6 hourly. However, due to persistent high grade fever with relative bradycardia and mild soft splenomegaly the possibility of enteric fever was considered and he was started on tablet Ciprofloxacin 500mg 12 hourly. The patient became afebrile after four days and remained so for the next three days of admission. He was then discharged symptom-free, with advice to continue tablet Ciprofloxacin 500mg 12 hourly for the next seven days.

On re-admission, he was febrile and toxic looking. According to the patient, he remained afebrile for about 15 days after completion of 2 weeks course of Ciprofloxacin. Later on, he started having high grade fever every second or third day. Fever used to persist for three to four hours, accompanied with chills, myalgias, nausea and sweating, leaving the patient exhausted and tired. He also complained of persisting discomfort in left lower part of chest which would aggravate on brisk walk and while lying on left lateral side. There was no history of cough, hemoptysis, skin rash, joint swelling, palpitations, dyspnea, diarrhoea, and urinary problems. His past and family history was unremarkable. He belonged to a rural background and had history of consuming raw goat milk. Clinically he was ill-looking, having temperature 101.5oF, B.P 115/70 mmHg, and pulse 106 per minute, regular in rate and rhythm. There was no pallor, lymphadenopathy, jaundice, skin rash, clubbing, edema, splinter hemorrhage or Janeway`s lesions. Spleen was palpable on finger below the costal margin. It was firm, non tender, mobile with smooth surface and regular edge. Rest of the clinical examination was unremarkable. On investigations, ultrasonography of abdomen revealed splenomegaly with a focal hypo-dense area measuring 3cms in diameter with minimal fluid collection suggestive of splenic abscess.

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