Salmonella splenic abscess

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A 14-year-old previously healthy male presented with 2 weeks of abdominal pain, vomiting, and diarrhea. On presentation, he was febrile and dehydrated. He was fluid resuscitated and provided anti-emetics. Evaluation was remarkable for leukocytosis, hyponatremia, normal serum bicarbonate, positive blood culture with Salmonella enterica, and positive stool PCR with S. enterica and enteropathogenic Escherichia coli. Computed tomography abdomen revealed small bowel enteritis and a 7-cm splenic lesion. Magnetic resonance imaging (MRI) showed an indeterminate complex cystic mass in the spleen with minimal peripheral enhancement concerning a splenic abscess (Figure 1). Ultrasound-guided percutaneous drainage (PCD) of the splenic abscess yielded 30 mL of old hemorrhagic and purulent material (Figure 2). Culture of the material was positive for S. enterica, confirming a Salmonella splenic abscess. On further history, he disclosed he had abdominal trauma from wrestling 1 week before presentation, which we suspect led to seeding of the spleen. He denied any new foods, travel, or animal contacts. Hematological and immunological workups were unremarkable. He was treated with ampicillin and transitioned to amoxicillin for 21 total days. Splenic abscesses are uncommon, with incidence estimated between 0.2% and 0.07%, with Salmonella being a rare cause. Various conditions that lead to a splenic abscess include trauma, hematogenous infection, immunodeficiency, and splenic infarction. Salmonella infections localized to the gastrointestinal tract are typically treated with supportive care. Splenectomy is traditionally the treatment for splenic abscesses; however, spleen-preserving method of PCD with antibiotics has become more common, with success ranging from 17% to 100% in adults.1-7 The authors declare no conflicts of interest. Written informed consent for the release of information was received from the parents. The patient of the case report and their parents are aware of the intent to publish and have agreed to it. We have obtained signed informed consent and archived it.

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