S6296 Isolated Splenic Abscess Due to Shigella flexneri in a Healthy Young Man: A Case Report

Introduction: Splenic abscesses are very rare and can lead to severe complications if not treated promptly. We report a case of an isolated splenic abscess in an otherwise healthy 18-year-old man, with blood cultures identifying Shigella flexneri (S. flexneri). The patient was treated conservatively with intravenous (IV) antibiotics and his symptoms resolved. Although splenectomy previously was regarded as the “gold standard” treatment, the trend is now moving towards a more conservative approach. Case Description/Methods: An 18-year-old man, working as a farmer, presented to the emergency department with a 2-week history of low-grade fevers, 3 days dull upper abdominal pain, and 2 days vomiting/diarrhea. The patient had been taking over-the-counter antipyretics and ciprofloxacin and cefixime for 4 days at home with no improvement. There was no history of trauma, recent blood transfusion, exposure to cattle and poultry, or unpasteurized milk consumption. There was a notable family history of a paternal cousin who was treated for a splenic abscess. On admission, vitals signs revealed he was febrile (100.4°F), heart rate 105, and blood pressure 90/60 mmHg. Abdominal exam showed a soft, non-distended abdomen with mild tenderness in the epigastric region and left upper quadrant. Pertinent labs included white blood cells 13.6 × 109/L, neutrophils 87.8%, C-reactive protein 92 mg/L, Hb 14 g/L, alanine transaminase 262 U/L, and aspartate aminotransferase 211 U/L. Abdominal ultrasound showed hepatosplenomegaly with spleen measuring 13 cm with multiple peripheral hypoechoic wedge-shaped areas measuring 46 × 25 mm and intraparenchymal lesions measuring 21 × 12 mm. Abdominal computed tomography imaging showed hypodense linear splenic areas, likely splenic abscess. He was empirically treated for enteric fever with ceftriaxone and azithromycin while awaiting blood culture results. Despite treatment, he remained febrile and experienced worsening abdominal pain. When patient did not show improvement, meropenem was added. Blood cultures identified S. flexneri. The patient was switched to intravenous (IV) sulzone and vancomycin and responded well and was afebrile by the sixth day of admission. The patient continued IV antibiotics for 4 weeks and was discharged with a 14-day course of oral linezolid and moxifloxacin, with an outpatient follow-up appointment. Discussion: Splenic abscesses are extremely uncommon; autopsy studies revealed their prevalence to be between 0.2%-0.7%. There is no universally accepted standard for managing splenic abscesses; instead, treatment should be tailored to the specific needs of each individual patient.