Conservative Management and Organ Preservation in a Unique Case of Group A Streptococcus Infection Causing Splenomegaly, Splenic Infarction, and Non-Traumatic Rupture Leading to Intra-Abdominal Abscess and Pleural Empyema

Abstract

Non-traumatic splenic rupture (NSR) is a clinical oddity. Most splenic ruptures occur due to trauma. Splenic abscess formation is also a rare occurrence. Majority of splenic infections are secondary to splenic infarction or infection that originates external to the spleen. We present a unique case of a 40-year-old previously healthy woman who presented with splenomegaly, splenic infection, infarction, non-traumatic rupture, abscess formation, and pleural empyema positive for group A Streptococcus pyogenes. She initially presented to the emergency department complaining of worsening epigastric abdominal pain, fever, chills, and progressive shortness of breath. A computed tomography (CT) scan of the chest, abdomen, and pelvis revealed hepatomegaly and splenomegaly with infarcts and lacerations. Elaborate hematologic, thromboembolic, and oncological workup were essentially negative. She was managed non-operatively with a long course of antibiotics and pleural and intra-abdominal drainage.




Clin Infect Immun. 2019;4(2):31-36
doi: https://doi.org/10.14740/cii80