Presentation
High grade fever for 4 days, associated with left hypochondrial pain and vomiting.
Patient Data
Spleen is grossly enlarged. Multiple hypoechoic splenic lesions without internal vascularity.
Multiple poorly demarcated hypodense lesions within the enlarged spleen. No significant peripheral enhancement or capsule for these lesions. The density of these lesions ranges from 18 till 30 HU.
Minimal ascites. Moderate degree of right pleural effusion.
Hepatomegaly. No focal liver lesion or collection.
No obvious collection within the prostate gland.
Most of the splenic lesions have resolved. A few subcentimeter well defined cystic/anechoic lesions at mid part of spleen.
Case Discussion
The patient has underlying chronic myeloid leukemia (CML) treated with oral tyrosine kinase inhibitor. The clinical presentation of fever , left hypochondrial pain and sonographic/CT features are suggestive of multiple splenic abscesses.
Blood culture isolated Burkholderia pseudomallei, proven to be melioidosis. The patient was treated with intravenous Ceftazidime for 4 weeks (intensive phase), followed by Bactrim for 3 months.
Splenic abscess is very common in the immunocompromised patients (leukemia, HIV, transplant/chemotherapy) especially if the abscesses appear to be multiple in number.
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