Infective endocarditis complicated with splenic abscess successfully treated with splenectomy followed by double...

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Treatment

Background:

• Infective endocarditis (IE) can lead to rare complications like splenic abscess (SA).
• Optimal treatment strategies for IE with SA remain unclear, with limited evidence guiding medical versus surgical interventions.
• Current guidelines suggest splenectomy before valve surgery, but this lacks strong evidential support.

Observation:

• A 73-year-old male presented with fever and fatigue, diagnosed with IE due to mitral and aortic regurgitation and a 10 mm vegetation.
• Initial medical therapy with antibiotics was administered due to a recent brain embolism.
• Despite effective initial antibiotic treatment, the patient developed left upper abdominal pain, diagnosed as SA via CT scan.

Findings:

• Vancomycin administration did not resolve the SA, necessitating surgical intervention.
• A splenectomy was performed, followed by successful mitral and aortic valve replacement 9 days later.
• This case highlights a successful treatment sequence of splenectomy preceding valve surgery for IE with SA.

Implications:

• This case report challenges existing guidelines by demonstrating the successful efficacy of performing splenectomy before valve surgery in managing IE with SA.
• The findings suggest a potential alternative surgical sequence that warrants further investigation in clinical practice.
• Further research is needed to establish definitive evidence-based guidelines for the surgical management of IE complicated by SA.