Simultaneous Renal and Splenic Infarctions Associated with Newly Diagnosed Atrial Fibrillation

Renal and splenic infarctions are uncommon causes of acute abdominal, flank, or back pain and may be overlooked because of their non-specific presentation. Atrial fibrillation is an important cause of systemic embolization; however, simultaneous renal and splenic infarctions associated with newly diagnosed atrial fibrillation are rarely reported. A 77-year-old woman presented to the emergency department with acute-onset epigastric, back, and flank pain. She had hypertension and diabetes mellitus. Physical examination revealed diffuse abdominal tenderness without guarding or rebound. Electrocardiography showed newly diagnosed atrial fibrillation. Laboratory tests revealed mild leukocytosis, markedly elevated lactate dehydrogenase (LDH), mildly elevated C-reactive protein, and slightly elevated D-dimer, while serum creatinine was normal. Contrast-enhanced abdominal computed tomography demonstrated a 5-cm non-enhancing splenic lesion and a 2-cm non-enhancing hypodense lesion in the right kidney, consistent with splenic and renal infarctions. CT angiography showed no significant arterial stenosis, mural thrombus, or aortic plaque formation. Anticoagulation with subcutaneous enoxaparin was initiated. Newly diagnosed atrial fibrillation may be associated with visceral embolic events. In patients with unexplained acute abdominal, back, or flank pain, the coexistence of elevated LDH and atrial fibrillation should prompt consideration of renal and splenic infarctions and early contrast-enhanced imaging.