Splenic infarction is an extremely rare and unique presentation of brucellosis. Only few cases have been reported worldwide. We here report a case of a young man, presenting with acute onset of fever, left hypochondial pain, and vomiting. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for endocarditis. Significant improvement in clinical symptoms and splenic lesions was achieved after six weeks of combination therapy against brucellosis.
Brucellosis is the most common zoonotic infection worldwide [
A 17-year-old boy, medically free, with history of unpasteurized milk ingestion, living in Shaqra (a village 200 km far from Riyadh, the capital of Saudi Arabia), presented to our emergency department with fever, vomiting, and malaise for 2 weeks followed by 5-day history of left hypochondrial pain. He lost 9 kgs in the preceding two months. He had no history of trauma or surgery. He was admitted to a peripheral hospital where he received a course of antibiotics with no improvement. On clinical examination, he looked ill, in pain with a temperature of 38.4 degree Celsius; pulse rate of 116 beats per minutes; blood pressure 111/68 mmHg; and respiratory rate of 21 breaths per minute. Abdominal examination revealed moderate tenderness in the left hypochondrium, no organomegaly on palpation and normal bowel sounds.
Abdomen CT without contrast showing multiple hypodense splenic lesions.
On the 8th day of admission, fever and abdominal pain resolved. High amylase and lipase were normalized and the patient was discharged home in good condition. After 3-month follow-up in outpatient clinic, the patient remained well with significant improvement of splenic infarcts on computed tomography (Figure
Repeated CT abdomen showing marked regression of the largest lesion while disappearance of others.
Vascular complications of brucellosis like deep venous thrombosis, infective endocarditis, and atrial aneurysm formation have been rarely reported [
The exact pathogenesis of this complication is not clear yet; however, different mechanisms were proposed such as damage to the adjacent tissue during an infectious process, septic embolism, endophlebitis, direct endothelial damage, induction of inflammation, and hypercoagulable state [
In our patient, the proinflammatory response induction caused by direct endothelial damage seems to be the most favorable explanation as cardiac and hypercoagulable studies were negative [
Acute pancreatitis is also a rare complication of brucellosis; only few cases were reported [
Symptoms of splenic infarction are nonspecific and may include left hypochondial pain, fever, and vomiting. CT abdomen without contrast is the best imaging modality for detecting splenic infarctions [
Our patient was managed conservatively and by commencing triple anti-
Anticoagulation administration in splenic infarction is still in debate [
Thrombocytopenia is a prominent laboratory finding in brucellosis. To our knowledge, thrombocytopenia was reported in the previous cases of splenic infarctions associated with brucellosis. In our case, normal platelet count was observed; therefore bone marrow biopsy was not considered.
Acute brucellosis should be in the differential diagnosis of patients with splenic infarctions especially in endemic areas. Excluding infective endocarditis is important to plan the duration of therapy and subsequent management.
The authors declare that there is no conflict of interests regarding the publication of this paper.