title: Splenic abscess as a potential initial manifestation of quiescent infective endocarditis in a patient with bronchopneumonia.
abstract: A 78-year-old woman presented to the acute medical unit with a productive cough, dyspnoea and decreased appetite of 4 days duration. Initial assessment supported a diagnosis of right-sided community-acquired pneumonia and she was started on antibiotics. In view of the clinical finding of splenomegaly, she had an ultrasound and, subsequently, a CT of the abdomen, which revealed a large splenic abscess. Pending cultures from a sample obtained from percutaneous drainage of the abscess, she was started on intravenous meropenem. The initial echocardiogram did not suggest any evidence of endocarditis. The pus drained from the abscess on cultures was subsequently positive for Staphylococcus aureus. An MRI of the spine excluded discitis as a source of infection. Owing to a high index of clinical suspicion a repeat echocardiogram was undertaken after 1-week, which confirmed acute endocarditis. The patient was treated with intravenous antibiotics for 6 weeks with improvement in clinical, radiological and biochemical parameters.
authors.affiliation: Department of Diabetes, Endocrinology and General Medicine, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: McOwat
authors.affiliation: Department of Diabetes, Endocrinology and General Medicine, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK.
authors.forename: Kah Fai
authors.initials: KF
authors.lastname: Wong
authors.affiliation: Department of Diabetes, Endocrinology and General Medicine, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK.
authors.forename: George I
authors.initials: GI
authors.lastname: Varughese
authors.affiliation: Department of Diabetes, Endocrinology and General Medicine, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK.
authors.forename: Ananth U
authors.initials: AU
authors.lastname: Nayak
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001996:Bronchopneumonia / Q000150:complications; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D013158:Splenic Diseases / Q000382:microbiology*; D013163:Splenomegaly / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents