Overview
Infection of the spleen, including conditions like splenic abscess, can arise from various etiologies, particularly in immunocompromised states such as hemodialysis patients 2.Diagnosis
Clinical Presentation: Unexplained fever, abdominal pain, and signs of systemic infection 2.
Imaging: Ultrasound, CT, or MRI to identify abscesses or other structural abnormalities 2.
Laboratory Tests: Elevated inflammatory markers (e.g., CRP, WBC) 2.
Culture and Sensitivity: Blood cultures and aspirates from splenic lesions to identify causative organisms 2.Management
Antibiotics: Empiric broad-spectrum antibiotics tailored based on culture results, targeting common pathogens like staphylococci 2.
Surgical Intervention: Considered for abscess drainage or splenectomy in cases of persistent infection or complications 2.
Supportive Care: Management of underlying conditions, fluid balance, and hemodynamic stabilization 2.Special Populations
Hemodialysis Patients: Increased vigilance for splenic abscesses, especially following access-site infections 2.
Pediatric Patients: Nonoperative management (NOM) is standard for blunt spleen injuries; interventional radiology may be used for hemorrhage control 1.Key Recommendations
Investigate hemodialysis patients with unexplained fever for splenic abscess, considering prior access-site infections 2 (Evidence: Moderate).
For pediatric patients with blunt spleen injuries, consider interventional radiology for managing acute hemorrhage under NOM 1 (Evidence: Moderate).
Empiric broad-spectrum antibiotic therapy should be initiated promptly in suspected splenic abscess, guided by culture results 2 (Evidence: Moderate).References
1 Miura N, Tsuchiya A, Katsura M, Sakoda N, Morita S, Nakagawa Y. Interventional radiology in pediatric blunt liver and spleen injuries: A multicenter retrospective observational study. The journal of trauma and acute care surgery 2025. link
2 Fonseca V, Baillod R, Berger L, Fernando O, Moorhead J. Splenic abscess in patients on hemodialysis. American journal of kidney diseases : the official journal of the National Kidney Foundation 1990. link80774-8)
3 Pinkus GS, Warhol MJ, O'Connor EM, Etheridge CL, Fujiwara K. Immunohistochemical localization of smooth muscle myosin in human spleen, lymph node, and other lymphoid tissues. Unique staining patterns in splenic white pulp and sinuses, lymphoid follicles, and certain vasculature, with ultrastructural correlations. The American journal of pathology 1986. link