Splenic abscess in cancer chemotherapy

Spleen abscesses occur more frequently in immunocompromised patients [1]. Infection with human immunodeficiency virus (HIV), the use of intravenous drugs, diabetes, immunosuppressive treatments, hepatic parenchymal disease (notably chemoembolization for hepatocellular carcinoma) or pancreatic neoplasia and alcoholism are more comorbidities reported [4, 5]. In our case, the patient was followed for metastatic lung cancer receiving chemotherapy, and admitted in an array of febrile neutropenia. The pathophysiology of splenic abscesses based on several theories: hematogenous theory where the spleen is infected during severe sepsis; the intrinsic theory where the infection occurs in an altered structure or function such as splenic infarction or splenic hematoma and extrinsic theory where the spleen is contaminated by an infection of the neighborhood [6, 7]. The first two theories can be accepted in our patient, especially since it was in anticancer chemotherapy. The bacteria most frequently involved are Staphylococcus aureus, Streptococcus, Enterobacteriaceae especially the salmonellosis and anaerobic [8]. In the case of our patient bacteriological study found a pyocianique certifying the nature of nosocomial infection probably spread through blood, when handling the implantable chamber. The symptoms of splenic abscess is polymorphic [9, 10]. Febrile painful splenomegaly is inconstant [7, 11]. Similarly, the peritonitis is a rare circumstance discovery. In some cases, symptoms boils down to infectious syndrome or persistent impairment of the general condition and the diagnosis is imaging [12]. In our patient, the infectious syndrome was at the forefront which delayed the diagnosis of 48 h. CT has the same reliability as ultrasound for the diagnosis of splenic abscess [10]. The treatment of splenic abscesses based on empiric antibiotic therapy secondarily adapted to bacteriological results more or less associated with ultrasound-guided puncture, Percutaneous drainage or splenectomy [13, 14]. Percutaneous drainage has the advantage of shortening the duration of hospitalization, preventing peritonitis due to rupture of the abscess and preserve the splenic parenchyma with cure rates ranging from 70 to 100 % [13, 14]. Conservative treatment seems to be more effective in the unique collections, with a thin wall, or in bad general condition of the patient [12–14]. Splenectomy remains a good indication if partitioned or multiple abscesses in case of failure of percutaneous treatment or in case of complicated abscesses [12]. Splenectomy was offered to our patient because of his land degradation. It is also clear that the total splenectomy puts them at increased risk of death from severe infections post-splenectomy with organ failure or overwhelming post splenectomy infection (OPSI) [15, 16]. It is necessary to prevent these infections in splenectomized by vaccination against Pneumococcus, Haemophilus and meningococcal and pneumococcal a long-term antibiotic prophylaxis with penicillin V [16].