title: [Splenic abscess secondary to massive bee bite in immunocompetent host. A case report].
abstract: BACKGROUND
  Spleen abscesses are considered as an infrequent infectious disease. An increase in its presentation has been seen due to certain pathologies or clinical conditions associated with immune suppression, endocarditis being one of the most frequent causes. Gram-positive aerobes are the main causal agents with non-specific clinical manifestations. CT scan and ultrasound are the elective choices for diagnosis and imaging support for punction and drainage.
  
  
  OBJECTIVE
  To describe the case of a patients with splenic abscess and its possible association with massive bee bite.
  
  
  METHODS
  A 51-year-old man, with no important medical history, suffered a massive bee bite and developed anaphylactic shock. He was managed at the emergency room where 116 bee stings were removed from the patient. He was discharged after 3 days. Eight days later he complained of abdominal pain localized in the left upper quadrant, persisting for 3 weeks. Abdominal pain increased and was accompanied by malaise, vomiting, fever, signs of peritonitis and leucocytosis. CT scan showed left pleural effusion, a single hypodense lesion in the inferior pole of the spleen, and thickness of the parenchyma. The patient was diagnosed with spleen abscess drained to cavity and was submitted to surgery. Surgical findings included localized peritonitis, friable spleen, and 200 ml of pus. Splenectomy was performed and IV antibiotic therapy was started. Blood culture, viral profile, Widal reactions, and serological test for HIV were negative. Secretion (pus) culture was positive for Enterococcus faecium.
  
  
  CONCLUSIONS
  Spleen abscess is a rare entity and unusual diagnosis, representing a high mortality in non-treated patients. According to our search, there is no literature-based evidence of a similar case with this association. This report represents the first case of the association between spleen abscess and massive bee bite.
authors.affiliation: Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Olivares-Becerra
authors.forename: Francisco
authors.initials: F
authors.lastname: Cuan-Orozco
authors.forename: Joel
authors.initials: J
authors.lastname: Michel-Dueñas
authors.forename: María Karina Lizbeth
authors.initials: MK
authors.lastname: López-Ramírez
authors.forename: Gabriela Abigail
authors.initials: GA
authors.lastname: Velázquez-Ramírez
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Ojeda
mesh_terms: D000038:Abscess / Q000209:etiology*; D000818:Animals; D001516:Bees; D016984:Enterococcus faecium; D016908:Gram-Positive Bacterial Infections / Q000209:etiology*; D006801:Humans; D007121:Immunocompetence; D007299:Insect Bites and Stings / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013158:Splenic Diseases / Q000209:etiology*