1
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Mohtadi M, Ozgur SS, Russo J, Ansari N, Michael P. Splenic Surprise: Investigating a Case of Splenic Infarct as an Isolated COVID-19 Manifestation. Cureus 2024; 16:e53438. [PMID: 38435155 PMCID: PMC10909243 DOI: 10.7759/cureus.53438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) infection has been associated with a multitude of complications, one established complication being thromboembolism, a result of the proinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This prothrombotic state is a cumulation of many inflammatory pathways at work. Here, we present an interesting case of a 43-year-old female who did not present with the typical COVID-19 clinical picture. Instead, she presented with periumbilical pain, nausea, and vomiting. Upon further investigation, she was found to have a splenic infarct on a computed tomography (CT) scan. An extensive workup was performed to explore possible etiologies; however, it was concluded that her splenic infarct was secondary to her COVID-19 infection. With this case, we aim to add to the literature regarding the manifestations of the prothrombotic state of SARS-CoV-2.
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Affiliation(s)
- Malina Mohtadi
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Sacide S Ozgur
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Joseph Russo
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Nida Ansari
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
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2
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Ramanan S, Singh H, Ahmed O, Zande M, Trimble M. A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity. Cureus 2023; 15:e46434. [PMID: 37927647 PMCID: PMC10622253 DOI: 10.7759/cureus.46434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Lambl's excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them being misdiagnosed as vegetations of endocarditis with patients failing to improve on conventional therapy. A 48-year-old female with a history of hypertension presented to the Emergency Department with a one-week history of sharp left upper quadrant pain. She was vitally stable; the only lab abnormality was revealed to be a mildly elevated white cell count. CT abdomen revealed a splenic infarct involving 25% of the parenchyma. Patients had no history of abdominal trauma, coagulation disorders, exogenous estrogen use or IV drug abuse. Subsequent investigations failed to reveal any cause of hypercoagulability. An extensive cardiac workup revealed no arrhythmias, but transesophageal echocardiogram showed a mobile echo density on the ventricular side of the aortic valve attached at the coaptation zone, approximately 2.7 cm long and 0.1 cm wide, suggesting a very prominent Lambl's excrescence. In the absence of any other findings, the patient's splenic infarct was determined to be secondary to an embolic event from the aortic valve lesion. Rivaroxaban was initiated and the patient subsequently improved. Existing literature describes most LEs as being asymptomatic and discovered incidentally on echocardiograms. This case illustrates the need to develop a criterion for prompt identification of LEs and differentiating them from the vegetations of endocarditis. It also brings forth the question of prophylactic treatment of these lesions while highlighting the lack of guidelines regarding the management of embolic phenomena secondary to LE.
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Affiliation(s)
- Sruthi Ramanan
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | | | - Omair Ahmed
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Mark Zande
- Cardiology, Henry Ford Health System, Jackson, USA
| | - Malcom Trimble
- Hematology Oncology, Henry Ford Health System, Jackson, USA
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3
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Kamra N, Jagadeesan S, Singh R. Scrub Typhus Presenting As Acute Febrile Illness With Splenic Infarct: A Rare Manifestation. Cureus 2023; 15:e45622. [PMID: 37868404 PMCID: PMC10588906 DOI: 10.7759/cureus.45622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Scrub typhus is a mite-borne infectious disease endemic in India, Korea, China, Japan, Taiwan, Pakistan, Malaysia, Thailand, and Australia. It has a multitude of clinical manifestations ranging from mild symptoms like headache, myalgia, anorexia, fever, and rash to severe multiorgan failure. It can also lead to several complications, including pancreatitis, hepatitis, myocardial infarction, and cerebral infarction. A few cases of splenic infarction are also reported. We report a rare case of a 40-year-old female presenting with fever and left upper quadrant abdominal pain of acute onset. She is diagnosed serologically with scrub typhus using enzyme-linked immunosorbent assay (ELISA) after ruling out other infectious causes, including other tropical diseases. Abdominal computed tomography revealed splenic infarction attributed to scrub typhus after excluding other etiologies. She improved after a course of doxycycline and was advised to follow up. Hence, a splenic infarct should be suspected in a patient with scrub typhus complaining of acute left hypochondriac pain.
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Affiliation(s)
- Namita Kamra
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Subramani Jagadeesan
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Ramandeep Singh
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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4
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Gupta A, Puri S, Aggarwal NP, Randhawa G, Jha PM. Typhoid Fever Complicated by Rhabdomyolysis with Acute Hepatitis, Splenic Infarct, Pancreatitis, and Acute Kidney Injury. Indian J Nephrol 2023; 33:147-149. [PMID: 37234442 PMCID: PMC10208540 DOI: 10.4103/ijn.ijn_497_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
Typhoid fever is a potentially life-threatening infectious disease that presents itself with a wide array of symptoms ranging from uncomplicated fever to sepsis with multiorgan dysfunction syndrome. An 18-year-old male college student presented with progressively increasing fever with abdominal discomfort, anorexia, and persistent vomiting. Typhoid fever was suspected in view of clinical findings along with leukopenia, grossly elevated transaminases, and acute kidney injury. He was managed with intravenous (IV) antibiotics, which resulted in the resolution of fever and other symptoms. Rhabdomyolysis is an extremely rare complication in typhoid fever, which is a very common cause of fever in tropical countries, leading to acute renal failure, causing very high morbidity and mortality.
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Affiliation(s)
- Ashish Gupta
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Saurabh Puri
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Neeru P. Aggarwal
- Department of Nephrology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Gulshan Randhawa
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Prem Mohan Jha
- Department of Nephrology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
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5
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Mavraganis G, Ioannou S, Kallianos A, Rentziou G, Trakada G. A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease. Healthcare (Basel) 2022; 10:150. [PMID: 35052313 DOI: 10.3390/healthcare10010150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.
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6
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Saini R, Jesrani G, Gupta M, Gupta S, Chhabra A. Salmonella paratyphi-induced splenic vein thrombosis: A case report on infrequent cause of acute abdomen. Turk J Emerg Med 2021; 21:210-213. [PMID: 34849434 PMCID: PMC8593428 DOI: 10.4103/2452-2473.329625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
Splenic vein thrombosis and splenic infarction are complications beyond the usual clinical spectrum of paratyphoid fever, and the presentation is rarely described. We report the case of a young female, who presented with high-grade fever and severe left upper quadrant pain. Her blood culture was positive for Salmonella paratyphi A, with Widal test suggesting 4-fold rise in titers. Computed tomography revealed splenic vein thrombosis and multiple splenic infarcts, for which antibiotic and anticoagulation were instituted simultaneously. She had a complete resolution with this management, and anticoagulation was tapered off on subsequent visits.
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Affiliation(s)
- Ruchika Saini
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Gautam Jesrani
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Samiksha Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Ankit Chhabra
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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7
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MacDougall K, Chukkalore D, Rehan M, Kashi M, Bershadskiy A. Acute promyelocytic leukemia presenting as recurrent venous and arterial thrombotic events: a case report and review of the literature. J Community Hosp Intern Med Perspect 2021; 11:832-838. [PMID: 34804401 PMCID: PMC8604466 DOI: 10.1080/20009666.2021.1973657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia characterized by a translocation of chromosomes 15 and 17, creating an alternation in the retinoic acid receptor-alpha (RAR-alpha) gene. This leads to excessive medullary production of promyelocytic blasts, which are frequently associated with the hemorrhagic complications seen in APL. In contrast, APL-associated thrombosis occurs much less frequently and is an underappreciated life-threatening manifestation of the disease. Most thrombotic events occur during induction chemotherapy with all-transretinoic acid and are rarely seen as the initial presentation on APL. Here we report an exceedingly rare case of a patient with recurrent venous and arterial thrombotic events, including deep vein thrombosis, bilateral segmental pulmonary embolism, an ischemic stroke, splenic infarcts, and renal infarcts, later found to have APL. We aim to discuss the most recent understanding of the pathogenesis of APL-associated thrombosis and to summarize the literature of this rare presentation of APL.
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Affiliation(s)
- Kira MacDougall
- Department of Internal Medicine, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, New York, NY, USA
| | - Divya Chukkalore
- Department of Internal Medicine, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, New York, NY, USA
| | - Maryam Rehan
- Division of Hematology & Medical Oncology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, New York, NY, USA
| | - Meena Kashi
- Department of Pathology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, New York, NY, USA
| | - Alexander Bershadskiy
- Division of Hematology & Medical Oncology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, New York, NY, USA
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8
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Vemireddy LP, Majlesi D, Prasad S, Tahir N, Parkash O, Jeelani HM, Shayuk M. Early Thrombosis of Splenic Artery Stent Graft. Cureus 2021; 13:e16285. [PMID: 34381645 PMCID: PMC8349697 DOI: 10.7759/cureus.16285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Splenic artery aneurysms (SAAs) are among the most common visceral aneurysms behind aortic and iliac arteries. Certain factors like aneurysm size (especially giant SAAs), hypertension (HTN), symptomatology, pregnancy, portal hypertension (pHTN), and liver transplantation increase the risk of rupture. Most often found incidentally, but when symptomatic, can present with nonspecific symptoms like nausea, vomiting, anorexia, and epigastric/left upper quadrant pain. Diagnosis can be accomplished with different modalities of CT or MRI and digital subtraction angiography (DSA) being the gold standard for diagnosis. Treatment is usually preferred for aneurysms >2 cm, symptomatic cases, and pregnant women. Various surgical/interventional procedures can be performed and selected based on the patient’s sex, age, location of the aneurysm, size of the aneurysm, and presenting complaints/complications. Endovascular techniques with or without stent-graft placement are being used more, given the minimally invasive nature of these procedures. No clear guidelines exist on initiation of dual antiplatelet therapy (DAPT), but based on guidelines from visceral arterial stenting (especially iliac arteries and renal arteries), multiple case reports/series on SAAs, we highly recommend the usage of DAPT pre- and post-stent-graft placement to improve patency.
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Affiliation(s)
| | | | - Sonika Prasad
- Internal Medicine, Chicago Medical School, McHenry, USA
| | - Nayha Tahir
- Internal Medicine, Northwestern Medicine McHenry Hospital, McHenry, USA
| | - Om Parkash
- Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | | | - Maryna Shayuk
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern Medicine McHenry Hospital, McHenry, USA
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9
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Norton EJ, Sheikh N. Splenic Infarct Due to a Patent Foramen Ovale and Paradoxical Emboli Post-COVID-19 Infection: A Case Study. Cureus 2021; 13:e14887. [PMID: 34109076 PMCID: PMC8180182 DOI: 10.7759/cureus.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypercoagulability is now a recognized complication of COVID-19 infection. Despite this, splenic infarction remains rare and is often found incidentally, radiologically, or at autopsy. We report a case of symptomatic splenic infarction with superimposed infection, secondary to COVID-19-induced hypercoagulability in a young patient with paradoxical emboli due to an undiagnosed patent foramen ovale (PFO). This multifactorial case should prompt a level of suspicion of the patient with unexplained abdominal pain and recent COVID-19 infection.
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Affiliation(s)
- Emma J Norton
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR.,Division of Anaesthesia, University of Cambridge, Cambridge, GBR
| | - Nadim Sheikh
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
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10
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Abstract
A high incidence of thromboembolic events and coagulation parameter abnormalities are seen in cases of coronavirus disease 2019 (COVID-19). Both venous and arterial thrombosis, including arterial thrombosis in unusual sites, have been reported in COVID patients in recent literature. Herein, we report a case of a 67-year-old female patient with non-critical COVID-19 disease with an incidental finding of an asymptomatic splenic infarct. In the absence of a cardio-embolic source, we believe this was an arterial thromboembolic event in the splenic circulation. The duration and modality of anticoagulation of inpatient and ambulatory COVID patients remains a dynamic discussion. Our case adds the evidence of a clinically silent arterial thrombotic event in a non-critical COVID-19 patient which further emphasizes the need to address the strategies for diagnosis and management of thrombo-embolism to prevent potentially fatal complications.
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Affiliation(s)
- Natasha Ghalib
- Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
| | - Prateek Pophali
- Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
| | | | - Apoorva Jayarangaiah
- Hematology/Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
| | - Abhishek Kumar
- Hematology/Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
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11
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Gonzalez L, Shapiro AF, Tafur A, Plaza-Meneses C, Sabando B. Splenic Infarct Secondary to High Altitude Exposure in Sickle Cell Trait Patients: A Case Series. Cureus 2020; 12:e9815. [PMID: 32821639 PMCID: PMC7431312 DOI: 10.7759/cureus.9815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The sickle cell trait is considered a benign entity that generally does not show clinical manifestations. However, some complications have been described under certain conditions, such as a decrease in oxygen level, dehydration, and strenuous physical efforts. Among them, splenic infarct is a rare complication that presents as left upper abdominal pain in a situation of stress such as high altitude exposure. We present two cases of splenic infarcts in patients with undiagnosed sickle cell trait who showed to our institution with severe abdominal pain after coming from high altitude cities.
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Affiliation(s)
- Luis Gonzalez
- Medicine, Nassau University Medical Center, East Meadow, USA
| | | | | | | | - Brenner Sabando
- Hematology, Hospital Luis Vernaza/Universidad Espíritu Santo (UEES), Guayaquil, ECU
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12
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Malik A, Onwubiko C, Chen M, Radulescu A, Galloway D, Martin C. Gastrosplenic Fistula without Malignancy Management in a 16-Year-Old Boy. European J Pediatr Surg Rep 2019; 7:e114-e116. [PMID: 31871851 PMCID: PMC6923715 DOI: 10.1055/s-0039-1678568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/30/2018] [Indexed: 11/18/2022] Open
Abstract
Gastrosplenic fistula is a very rare entity, most commonly occurring as a distinctive complication of splenic or gastric malignancies, most notably diffuse large B cell lymphoma (DLBCL). Benign gastric ulcer, splenic abscess, and Crohn's disease have also been reported as possible causes. We report a nonmalignant case of 16-year–old male with a gastrosplenic fistula of unclear etiology. The fistulous tract was confirmed by an upper endoscopy and an upper gastrointestinal series. Subsequently, it was surgically managed with a subtotal gastrectomy with “Roux-en-Y” reconstruction and a feeding jejunostomy.
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Affiliation(s)
- Aila Malik
- Medical College, CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Chinwendu Onwubiko
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mike Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Andrei Radulescu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Department of Surgery, Loma Linda University Adventist Health Sciences Center, Loma Linda, California, United States
| | - David Galloway
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Colin Martin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
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13
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Kumar R, Kapoor R, Singh J, Das S, Sharma A, Yanamandra U, Nair V. Splenic Infarct on Exposure to Extreme High Altitude in Individuals with Sickle Trait: A Single-Center Experience. High Alt Med Biol 2019; 20:215-220. [PMID: 31407926 DOI: 10.1089/ham.2018.0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Sickle cell trait (SCT) is a common genetic abnormality in the so-called "sickle belts" in India. Splenic infarction often brings to medical attention an underlying SCT, when appropriately looked for. The hypoxic environment of an extreme high-altitude area (HAA) is conducive for developing a splenic infarct in an SCT individual not a native of these areas. Aims: We studied retrospectively 27 cases who presented with a splenic infarction during the last 4 years. Results: Twenty-five patients (92.5%) were diagnosed to have SCT, and 85% patients had developed splenic infarct on exposure to very HAAs. Clinically, splenomegaly was seen in 33% of patients with splenic infarct at presentation. The mean hemoglobin S was 36.92% in SCT individuals. A thrombus in the splenoportal axis was demonstrated in 22.2% of cases. Splenic rupture was a rare event, seen in only 3.5% of patients. Splenectomy was not required in any of the cases. Splenic abscess was not seen, and antibiotics were not required in any of the cases. We discuss the profile and management of these patients and review the literature on splenic infarction in HAA. Conclusion: SCT is commonly overlooked cause of splenic infarction and conservative management is effective in most of the cases. Splenectomy is required only in the rarest of rare cases. The profile and management of these patients and a review of the literature on splenic infarction in HAA has been discussed.
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Affiliation(s)
- Rajiv Kumar
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Rajan Kapoor
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Jasjit Singh
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Satyaranjan Das
- Department of Pediatrics and Clinical Hematology, Army Hospital (R&R), New Delhi, India
| | - Ajay Sharma
- Department of Hematology & BMT, Sir Ganga Ram Hospital, New Delhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India
| | - Velu Nair
- General Army Medical Services, IHQ, MOD, New Delhi, India
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14
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Abstract
Splenic infarction is a rare cause of abdominal pain. We herein reported a unique case of a 30-year-old male patient who developed a splenic infarct during the acute phase of Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) and was subsequently found to have the presence of antiphospholipid antibodies (APA).
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Affiliation(s)
- Salman Khan
- Internal Medicine, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
| | - Shakir Saud
- Family Medicine, Rutgers New Jersey Medical School, Newark, USA
| | - Imran Khan
- Internal Medicine, North Shore University Hospital, Hempstead, USA
| | - Sheela Prabhu
- Internal Medicine, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
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15
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Noor M, Sadough M, Chan S, Singh G. Splenic infarct in a patient with Infectious Mononucleosis: a rare presentation. J Community Hosp Intern Med Perspect 2017; 7:248-250. [PMID: 29046754 PMCID: PMC5637648 DOI: 10.1080/20009666.2017.1361291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/20/2017] [Indexed: 12/26/2022] Open
Abstract
We report a case of a 25-year-old obese, currently smoking, female diagnosed with EBV infectious mononucleosis. The patient complained of sudden onset abdominal pain with progressively increasing intensity in the left upper quadrant. Abdominal CT scan showed a wedge infarct of the spleen. We present this rare case that EBV may cause splenic infarct in young adults.
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Affiliation(s)
- Mustafa Noor
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Maryam Sadough
- Internal Medicine, Babol University of Medical Science, Baltimore, MD, USA
| | - Stephanie Chan
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
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16
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Abstract
Infective endocarditis (IE) is caused due to the vegetation on the heart valves, myocardium wall, or the pacemaker leads. Vegetation is a lesion that appears as a consequence of successive deposition of platelets and fibrin on the endothelial surface of the heart. Colonies of microbes can be usually found under the vegetation. Heart valves are involved more frequently as compared to other places. Streptococcus mitis, formerly known as S. mitior, is a commensal of the oral flora, however, if there of loss of integrity of the mucous membrane, the infection may disseminate to the blood flow. We describe here a rare presentation of S. mitis, causing IE and its complications in an immunocompetent patient.
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Affiliation(s)
| | - Rajeswer Sarasam
- Department of Medicine and Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Siddharth Wartak
- Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Vinod Namana
- Department of Medicine, Baystate Medical Center, Springfield, MA, USA
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17
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Ozgokce M, Ayyildiz V, Ogul H. An uncommon variation of the coeliac trunk in an adult patient with a splenic infarct : computed tomography angiography findings. Acta Gastroenterol Belg 2017; 80:331-333. [PMID: 29560707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mesut Ozgokce
- Department of Radiology, Van Regional Training and Research Hospital, Van, Turkey
| | - Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Kumar V, Soni P, Dave V, Harris J. Unusual Presentation of Diffuse Large B-Cell Lymphoma With Splenic Infarcts. J Investig Med High Impact Case Rep 2017; 5:2324709617690748. [PMID: 28203580 PMCID: PMC5298475 DOI: 10.1177/2324709617690748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/16/2016] [Accepted: 12/26/2016] [Indexed: 11/26/2022] Open
Abstract
A 67-year-old man presented with a 3-day history of abdominal pain, fever, and significant weight loss over 2 months. Physical examination revealed left upper quadrant tenderness, hepatomegaly, splenomegaly, and bilateral pitting edema but peripheral lymphadenopathy was absent. Laboratory tests showed anemia, thrombocytopenia, elevated prothrombin time (PT), partial thromboplastin time (PTT), and increased lactate dehydrogenase (LDH). PTT was corrected completely in mixing study. Further workup for the cause of coagulopathy revealed decreased levels of all clotting factors except factor VIII and increase fibrinogen levels, which ruled out disseminated intravascular coagulation (DIC). Flow cytometry of peripheral blood was normal. Contrast-enhanced computed tomography (CECT) revealed splenomegaly with multiple splenic infarcts without any mediastinal or intraabdominal lymphadenopathy. Further investigations for infective endocarditis (blood cultures and transthoracic echocardiography) and autoimmune disorders (ANA, dsDNA, RA factors) were negative. The patient received treatment for sepsis empirically without any significant clinical improvement. The diagnosis remained unclear despite extensive workup and liver biopsy was conducted due to high suspicion of granulomatous diseases. However, the liver biopsy revealed high-grade diffuse large B-cell lymphoma (DLBCL). Unfortunately, patient died shortly after the diagnosis. Here we report a case of high-grade DLBCL with hepatosplenomegaly and splenic infarcts in the absence of any lymphadenopathy or focal lesions. This case highlights the fact that unusually lymphoma can present in the absence of lymphadenopathy or mass lesion mimicking autoimmune and granulomatous disorders. The diagnosis in these cases can only be made on histology, and hence the threshold for biopsy should be low in patients with unclear presentations and multiorgan involvement.
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Affiliation(s)
- Vivek Kumar
- Maimonides Medical Center, Brooklyn, NY, USA
| | - Parita Soni
- Maimonides Medical Center, Brooklyn, NY, USA
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Abstract
We are describing a case of an 18-year-old male patient with cytomegalovirus (CMV) associated guillain-barre syndrome (GBS) who presented with an acute onset of generalized weakness and numbness in the extremities, dysphagia, and facial diplegia, followed by respiratory failure, which led to mechanical ventilation. He had positive immunoglobulin G and immunoglobulin M antibodies against CMV, and CMV polymerase chain reaction was positive with <2000 copies of deoxyribonucleic acid. Human immunodeficiency virus test was negative. He received a course of ganciclovir, intravenous immunoglobulin, and plasmapheresis. After improving from acute episode, patient was transferred to a rehabilitation facility for physical and occupational therapy. At the rehabilitation facility, he exhibited signs of acute abdomen with pain in the left upper quadrant secondary to peritonitis from dislodged gastrostomy tube and underwent exploratory laparotomy. During the hospital course he was found to have splenic infarct and colitis on the computed tomography of abdomen. This case showed an immunocompetent young patient with multisystem complications including guillain-barre syndrome (GBS), splenic infarct, hepatitis, and colitis due to CMV.
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Affiliation(s)
| | - Murali Krishna Gurram
- Department of Internal Medicine, Health East Care System, Saint Paul, Minnesota, USA
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