Splenic syndrome in sickle cell trait: four case presentations and a review of the literature.
Four cases of splenic infarction/sequestration in sickle cell trait (SCT) patients are presented. All four patients were undergoing moderate exercise at elevations ranging from 5,500 to 12,000 feet. The patients include two African-American males, a Hispanic male, and a white female. All four presented with the acute onset of mid epigastric then left upper-quadrant pain, nausea, vomiting, and respiratory splinting. A review of the literature indicates that splenic infarction with SCT is not uncommon; however, not surprisingly, it is often initially misdiagnosed. This is the first report in the literature of a female with SCT incurring a splenic syndrome with exposure to terrestrial altitude. Although SCT is not a contraindication for moderate- or high-altitude activities, military physicians need to consider the diagnosis of splenic infarction early in any patient regardless of race or sex who presents with left upper-quadrant pain at altitudes above 5,000 feet. Prompt evacuation to sea level may hasten recovery and spare further splenic trauma. Although SCT should be considered a relatively benign entity, the literature also suggests a higher than average risk of sudden death in military recruits with SCT from exertional heat illness and rhabdomyolysis.
Franklin
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1st Marine Division, Camp Pendleton, CA 92055-5300, USA.
Compeggie
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D000328:Adult; D000531:Altitude; D000755:Anemia, Sickle Cell / Q000150:complications*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D013159:Splenic Infarction / Q000175:diagnosis / Q000209:etiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed