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May 1983

Splenic Abscess Complicating Infectious Endocarditis

Author Affiliations

From the Section of Infectious Diseases (Drs Raff, Johnson, Barnwell, and Chun), the Departments of Medicine and Microbiology and Immunology (Dr Raff), the University of Louisville School of Medicine.

Arch Intern Med. 1983;143(5):906-912. doi:10.1001/archinte.1983.00350050064013

• Infective endocarditis is the most common condition predisposing a patient to splenic abscess, and the conditions of 37 such patients are reviewed herein. Streptococci accounted for 18 abscesses, with six containing enterococci; 12 others contained staphylococci. Symptoms suggesting splenic abscess include abdominal distention, hiccups, and pain in the left flank, abdomen, and shoulder. Physical signs include recurrent or persistent fever and abdominal tenderness, with splenomegaly often inapparent. The most frequent finding on x-ray film is pleural effusion on the left side. Seventeen patients not undergoing splenectomy died; in these, the diagnosis of splenic abscess was established postmortem. Twenty patients underwent splenectomy, 19 of whom received antibiotics and survived; one patient who was not treated with antibiotics died. Physicians should suspect splenic abscess in patients with endocarditis, particularly those with staphylococcal or enterococcal endocarditis. Those patients with clinical evidence suggestive of splenic abscess should undergo specific diagnostic studies, and exploratory laparotomy may be necessary.

(Arch Intern Med 1983;143:906-912)