title: Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture.
abstract: A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma scan showed free intraperitoneal fluid and an emergency laparotomy revealed massive bleeding from a ruptured spleen. The patient was successfully resuscitated. She proved to be infected with cytomegalovirus causing idiopathic thrombocytopenic purpura, splenomegaly and splenic rupture. She was treated for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach was essential for the management and the eventual recovery of the patient.
authors: Department of Infectious Disease, Odense University Hospital, Odense, Denmark.
authors: Matilde Kanstrup
authors: MK
authors: Glesner
authors: Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors: Kristian Roerbaek
authors: KR
authors: Madsen
authors: Surgical Department A, Odense University Hospital, Odense, Denmark.
authors: Jesper Meng Rahn
authors: JM
authors: Nielsen
authors: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors: Stefan
authors: S
authors: Posth
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D004630:Emergencies; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D000077731:Meropenem; D012422:Rupture, Spontaneous / Q000601:surgery / Q000821:virology; D013156:Splenectomy / Q000379:methods; D013161:Splenic Rupture / Q000601:surgery* / Q000821:virology*; D013845:Thienamycins / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D013845:Thienamycins; D000077731:Meropenem; D015774:Ganciclovir