Follow up MRI of the abdomen (24 days after admission).

Multiple aseptic splenic abscesses in a 15 year old patient.

Jordan AJ, Becker KP, Sertemir M, Neff KW, Adam R, Schroten H, Tenenbaum T -BMC gastroenterology(2014)

Follow up MRI of the abdomen (24 days after admission). A, the coronal T2w image shows hyperintense lesions with hypointense rim in the spleen. B and C, the coronal postcontrast T1w image and transverse DW image (b 800 sec/mm2), show an increased number and size of the lesions.

F2:Follow up MRI of the abdomen (24 days after admission). A, the coronal T2w image shows hyperintense lesions with hypointense rim in the spleen. B and C, the coronal postcontrast T1w image and transverse DW image (b 800 sec/mm2), show an increased number and size of the lesions.

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Affiliation:Paediatric Infectious Diseases, Department of Paediatrics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. tobias.tenenbaum@umm.de.

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Bottom Line:We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patient's clinical condition and inflammatory parameters.Eventually corticosteroid therapy led to complete and long lasting resolution of symptoms.Anaerobic bacteria may play a role in the pathogenesis of the disease and besides corticosteroid treatment antibiotics covering anaerobes may be beneficial.

Abstract

Background: Splenic abscesses in children are rare. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults.

Case presentation: We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patient's clinical condition and inflammatory parameters. Eventually corticosteroid therapy led to complete and long lasting resolution of symptoms. Further diagnostic work-up revealed autoimmune thyroiditis, but no signs of inflammatory bowel disease.

Conclusion: Aseptic splenic abscesses should always prompt clinicians to initiate further diagnostics to determine a potential underlying condition and a regular follow-up. Anaerobic bacteria may play a role in the pathogenesis of the disease and besides corticosteroid treatment antibiotics covering anaerobes may be beneficial.

Mentions

On admission the patient was started on ceftriaxone and clindamycine leading to no clinical improvement except cessation of fever but CRP even rose (129 mg/L). Therefore, antibiotics were switched to meropenem and metronidazole after 4 days. Under this regimen she physically improved, the pharyngeal aphthae healed and inflammatory parameters decreased (WBC 10.98 × 109/L, CRP 26.5 mg/L) so that she could be discharged after 9 days continuing antibiotic treatment with doxycycline. In the follow up examination 24 days after initial presentation the splenic lesions increased in number and in size (Figure 2). Moreover the inflammatory parameters had risen again (WBC 14.19 × 109/L, CRP 175 mg/L). Subsequently, a computed tomography-guided needle biopsy was performed. The patient was restarted on meropenem and metronidazole. Using this therapy the CRP decreased and the white blood cell count normalized again (WBC 9.86 × 109/L, CRP 75.8 mg/L) within 9 days.

MeSH

Major

Abdominal Abscess/drug therapy*/microbiology

Anti-Inflammatory Agents/therapeutic use*

Prednisone/therapeutic use*

Splenic Diseases/drug therapy*/microbiology

Minor

Adolescent

Anti-Bacterial Agents/therapeutic use

Female

Humans