Gross splenomegaly in SLE

Spontaneous rupture of the spleen: an unusual complication of systemic lupus erythematosus

Although splenic abnormalities are widely recognised in patients with lupus, spontaneous rupture of the spleen is rare. We describe a patient whose spleen ruptured spontaneously 19 years after the onset of her disease, and compare this case with four others that have been described in the previous literature. Possible contributing factors to this rupture are discussed.

Splenic involvement in rheumatic diseases

OBJECTIVES

To assess the major reports of splenic involvement in the rheumatic diseases and to highlight several conditions in which potentially life-threatening splenic complications may occur.

METHODS

A search of the Medline database ('SilverPlatter': 1966 to 1997) was conducted for all English-language entries related to the spleen and the major rheumatic diseases. Original articles were reviewed from the bibliographies of these Medline-sourced articles. The major rheumatological textbooks were also reviewed for original references.

RESULTS

Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and polyarteritis nodosa (PAN) are at risk of experiencing spontaneous splenic rupture. Splenomegaly is common in both uncomplicated RA and as a feature of Felty's syndrome, in which the patient may be at risk of splenic abscess formation, again a possible complication of SLE and also PAN. Massive splenomegaly appears to be specific to SLE and may be confused with a malignant process. Abnormal splenic function has been documented in RA, SLE, and Wegener's granulomatosis. The spleen may show areas of infarction in several conditions, notably SLE and Wegener's granulomatosis. Splenic atrophy is not uncommon in SLE and may be associated with functional asplenia and a co-incident risk of potentially fatal infection with capsulated organisms.

CONCLUSIONS

Serious and occasionally fatal complications within the spleen occur in many rheumatic diseases. Prompt recognition of these complications is important.