Multiple splenic nodules with fever: a case of splenic abscess due to Propionibacterium acnes

A 64-year-old man with a history of chronic lymphocytic leukemia (CLL) presented in the hematology department due to remarkable leukocytosis and progressing anemia. Ultrasound confirmed splenomegaly and plain computed tomography revealed multiple hypoattenuating areas in the large spleen. Following a clinical diagnosis of relapse of CLL, he underwent treatment with fludarabine, cyclophosphamide, and rituximab (FC-R). After five cycles of FC-R treatment, his leukocyte count and hemoglobin level were normalized, and the size of the spleen also decreased. He began to have intermittent high fever (38 °C), however, approximately 6 months after the initiation of FC-R treatment. The results of an interferon-gamma release assay were positive. (18)F-fluoro-2-deoxy-D-glucose positron emission tomography showed multiple areas of high-uptake in the spleen, which was unclear in other radiologic modalities. We performed a splenectomy for the high fever and to confirm the diagnosis. Tissue cultures of the infarcted area of spleen were positive for Propionibacterium acnes. After splenectomy, the patient's condition improved and there were no further episodes of fever. Until recently, three cases of splenic abscess caused by Propionibacterium acnes were reported. Here we present a fourth case of splenic abscess due to Propionibacterium acnes and review the literature.