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[Splenic involvement in infectious endocarditis. 5 clinical cases and 78 necropsies]
Abstract:
Splenic involvement is a classical complication of infective endocarditis (IE). Clinical manifestations are rare, 5 out of 100 IE: unexpected rupture (1 case), abscess causing reinfection (2 cases), pseudo-tumour (1 case) and terminal infarction (1 case). In addition to a review of the literature, a post mortem histological study of the spleen of 78 cases of IE was undertaken. Splenic involvement did not seem to be the direct cause of death. Three types of lesions which may or may not be associated were observed: congestive inflammatory lesions, infarction (48 p. 100), abscess (6 p. 100). Splenic infarction usually results in scarring but may progress to abscess formation. Rupture was not observed in this autopsy series. Although splenic involvement is common at post mortem it gives rise to few symptoms. Persistant pyrexia and the appearance of local signs should lead to investigation of splenic complications and eventually, to surgical ablation.
Insights
Infective endocarditis (IE) frequently affects the spleen, often without obvious symptoms. Autopsy studies reveal splenic infarction and abscesses are common, though rarely the cause of death.
Area of Science:
- Cardiology
- Pathology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Splenic complications are known but often asymptomatic.
- Understanding these complications is crucial for patient management.
Observation:
- A post-mortem histological study examined 78 cases of IE.
- Splenic lesions included congestive inflammatory changes, infarction (48%), and abscesses (6%).
- Clinical manifestations of splenic involvement were rare.
Findings:
- Splenic infarction is common, potentially leading to scarring or abscess formation.
- Abscesses can cause reinfection.
- Rupture was not observed in this series, but pseudo-tumors and terminal infarction were noted.
Implications:
- Splenic complications of IE are frequent at autopsy but seldom symptomatic.
- Persistent fever and local signs warrant investigation for splenic issues.
- Early detection may necessitate surgical intervention for splenic complications.