title: Spleen rupture associated with septic emboli and endocarditis in a hemodialysis patient.
abstract: We present an uremic patient on chronic hemodialysis with splenic septic emboli associated with active infective endocarditis and anaerobic bacteremia complicated by ruptured spleen. A 62-year-old female patient was admitted because of fever and pain in the left upper abdomen and swelling and hematoma around the left brachiocephalic arteriovenous fistula. Transthoracic echocardiography revealed mobile hyperechoic mass (vegetation) on the anterior mitral valve. Abdominal ultrasound scan showed multiple hypoechoic lesions of the enlarged spleen, described as possible necroses or abscesses, and computed tomography showed low-density inhomogeneous lesions in the enlarged spleen with large perisplenic hematoma, with spleen rupture. Blood culture revealed anaerobic Gram-negative bacilli ( Bacteroides spp.), ampicillin resistant. This is the first report of splenic rupture associated with anaerobic bacteremia and splenic septic emboli in a uremic patient on chronic hemodialysis. Splenic septic emboli with abscess/infarction in hemodialysis patients are a rare disorder but could be a consequence of dialysis access site infection and might predispose to splenic rupture. Ultrasound scan of abdomen is fast, inexpensive and easy to perform. As mortality is high, early surgical intervention on vascular access is mandatory.
authors: Department of Nephrology and Dialysis, University Hospital Center Split, Split, Croatia. vedkovac@inet.hr
authors: Vedran
authors: V
authors: Kovacic
authors: Dragan
authors: D
authors: Ljutic
authors: Ivo
authors: I
authors: Jelicic
authors: Milenka
authors: M
authors: Sain
authors: Josipa
authors: J
authors: Radic
authors: Mislav
authors: M
authors: Radic
mesh_terms: D001442:Bacteroides Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D004617:Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology / Q000473:pathology; D006435:Renal Dialysis; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology; D013161:Splenic Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D014511:Uremia / Q000473:pathology / Q000628:therapy