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Splenic microabscesses in the immune-compromised patient
R M Hatley1, J S Donaldson, J G Raffensperger
1Department of Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614.
Journal of Pediatric Surgery
|July 1, 1989
Summary
Splenic abscesses in immunocompromised children treated with chemotherapy can be challenging to diagnose. Early CT scans and, if necessary, splenectomy are crucial for managing fungal infections.
Area of Science:
- Pediatric Infectious Diseases
- Medical Imaging in Oncology
- Surgical Management of Splenic Abscesses
Background:
- Immunocompromised children undergoing antineoplastic chemotherapy are susceptible to opportunistic infections.
- Recurrent fever and abdominal pain in these patients warrant thorough investigation for intra-abdominal pathology.
Observation:
- Four pediatric patients on chemotherapy presented with persistent fever, abdominal pain, and negative fungal blood cultures despite mucocutaneous and urinary candidiasis.
- Computed tomography (CT) scans revealed multiple splenic focal defects, suggestive of fungal infection, which were not clearly visualized by ultrasonography or nuclear scans.
Findings:
- Histological examination of spleen specimens post-splenectomy confirmed fungal infections (Candida and Aspergillus) in three of the four children.
- Splenectomy led to rapid defervescence and clinical improvement in all patients, despite negative operative cultures.
Implications:
- Persistent unexplained fever in immunocompromised patients necessitates abdominal CT to identify splenic lesions.
- Multiple splenic lesions on CT are highly indicative of fungal disease.
- Splenectomy is a potentially life-saving intervention for fungal splenic abscesses unresponsive to antifungal therapy.