From Trauma to Functional Asplenia: A Rare Case of Delayed Splenic Liquefaction and Infection

Delayed complications following blunt splenic trauma are uncommon and typically present within weeks to months. Late presentations occurring years after injury are rare and may pose diagnostic challenges, particularly when imaging mimics infectious pathology. We report a case of a 28-year-old male with features suggestive of nephrotic syndrome, who presented with abdominal pain, edema, and constitutional symptoms. Imaging performed six months prior had suggested a splenic abscess; however, further evaluation revealed diffuse hypoattenuation of the spleen with absence of contrast enhancement, consistent with complete splenic devascularization. The patient had a remote history of blunt abdominal trauma two years prior, which had remained untreated. Ultrasound-guided aspiration yielded sterile, necrotic fluid, favoring a chronic post-traumatic process rather than active infection. Microbiological evaluation revealed streptococcal pneumonia. The findings were consistent with chronic splenic injury with near-complete liquefactive transformation leading to functional asplenia in the background of nephrotic syndrome. The patient was managed conservatively with antibiotics and supportive care. This case highlights an unusual delayed presentation of severe splenic injury occurring years after trauma, resulting in functional asplenia and increased susceptibility to infection. It underscores the importance of correlating imaging findings with remote trauma history and considering functional asplenia in patients with extensive splenic devascularization. Early recognition of such atypical presentations is essential to guide appropriate management and prevent complications.