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Abstract:
Nineteen patients with fungal splenic abscesses included 16 with leukemia, one drug user, one patient with Cushing's syndrome, and one without predisposing causes. Fifteen had persistent fever; six had esophageal or mucocutaneous candidiasis. Abdominal pain occurred in seven patients, splenomegaly occurred in six, and left abdominal mass occurred in one. Three chest x-ray films showed left pleural effusions; two had elevated left hemidiaphragms, two had left-sided infiltrates, and one was normal. Sixteen of 17 technetium Tc 99m sulfur colloid scans were abnormal, as were 15 gallium citrate Ga 67 scans. Two computed tomographic studies revealed splenic defects. Candida was the cause in 15 cases, Aspergillus was the cause in three cases, and Blastomyces dermatitidis was the cause in one case. Sixteen patients underwent splenectomy, 12 receiving postoperative antifungal therapy. Fifteen survived regardless of underlying disease or hepatic microabscesses.
Insights
Fungal splenic abscesses, often seen in leukemia patients, can be effectively treated with splenectomy and antifungal therapy, leading to good survival rates even with co-existing conditions.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Abdominal Imaging
Background:
- Fungal splenic abscesses are rare but serious infections.
- Patients with hematologic malignancies, particularly leukemia, are at increased risk.
- Diagnosis can be challenging due to non-specific symptoms.
Observation:
- Nineteen patients with fungal splenic abscesses were identified.
- Common predisposing factors included leukemia (16/19), intravenous drug use, Cushing's syndrome, and idiopathic cases.
- Presenting symptoms included persistent fever (15/19), candidiasis (6/19), abdominal pain (7/19), and splenomegaly (6/19).
- Radiological findings included pleural effusions, elevated hemidiaphragms, and infiltrates on chest X-ray.
- Nuclear medicine scans (Technetium-99m sulfur colloid and Gallium-67 citrate) and computed tomography (CT) demonstrated splenic abnormalities.
Findings:
- Candida species were the most common causative agents (15/19), followed by Aspergillus (3/19) and Blastomyces dermatitidis (1/19).
- Splenectomy was performed in 16 patients, with 12 receiving postoperative antifungal treatment.
- Fifteen patients survived the infection, irrespective of their underlying conditions or presence of hepatic microabscesses.
Implications:
- Early diagnosis and aggressive management, including splenectomy and antifungal therapy, are crucial for improving outcomes in fungal splenic abscesses.
- Splenic abscesses should be considered in immunocompromised patients presenting with persistent fever and abdominal symptoms.
- Further research into non-invasive diagnostic methods and optimized antifungal regimens is warranted.