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Medical Pulse Is Compiled and Collated, please do not reprint
01 Case data
The patient is a 45-year-old, farmer by profession and is previously in good health
On admission to the hospital, the patient was pale, with a heart rate of 114 beats per minute, blood pressure of 110/70 mmHg, and a state
Laboratory tests show positive cell anemia, and no atypical or blast cells are found in the peripheral blood
Abdominal ultrasonography shows splenomegaly and the presence of free fluid
(Figure 1 CT scan)
Hepatitis B and C virus, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and HIV virus serology are negative
After surgical consultation, conservative treatment of splenic rupture is considered, and patients undergo intravenous fluids, blood transfusions, and clinical and biochemical monitoring, and begin to receive a combination of rifampicin, doxycycline, and streptomycin for brucellosis
02 Analytical discussion
Splenome rupture is a common complication after blunt abdominal trauma, and spontaneous splenomegaly is a spontaneous rupture of the spleen that occurs without a clear history of trauma, also known as non-traumatic splenomegaly
.
Spontaneous splenomegaly is rarely seen clinically, and its occurrence is usually related to pathological changes in the spleen or systemic diseases (such as inflammation, tumors, hematologic diseases, etc.
) in patients, and normal spleens rarely occur
.
Non-traumatic splenomegaly may have been the first symptom of previously undiagnosed disease, and in this case brucellosis was a potential cause of
splenomegaly.
Spontaneous splenomegaly due to brucellosis is very rare, with only a few cases reported
.
Brucellosis (brucellosis) is a natural zoonotic disease caused by Brucella, which is a systemic disease that can cause multi-organ involvement throughout the body, and is clinically characterized
by fever, hyperhidrosis, wandering joint pain, low back pain, hepatosplenomegaly and lymphadenopathy.
The underlying mechanism leading to spontaneous splenomegaly can be attributed to splenomegaly, particularly pathological infiltrates of the envelope, spleen infarction with subcapsular hemorrhage, and sometimes coagulation disorders
.
In addition, the course of infection can lead to congestion and dilation of the splenic sinuses and red myelin cord, making the spleen prone to bleeding and rupture
.
Ultrasonography is the primary basis for the diagnosis of splenomegaly rupture, generally showing enlarged spleen, hypoechondria, subcapsular and percapsular hematomas, and free fluid
in the abdominal cavity.
CT scans are helpful in the diagnosis and grading
of spleen injury.
Treatment of splenic rupture depends mainly on the level of splenic injury and the hemodynamic stability
of the patient.
If haemodynamic instability occurs, severe splenic injury, haemoglobin plummets below 10 g/dL, or clinical deterioration is further, selenectomy and laparotomy
are considered.
Conservative treatment may be chosen in patients with low-grade splenic injury and hemodynamically stable without further clinical exacerbation to prevent post-splenectomy complications
.
The patient in this case recovered completely with conservative treatment and triple anti-brucellosis
therapy.
The incidence of spontaneous splenomegaly rupture is low, the etiology is complex, and the patient lacks a typical history of trauma, which can easily lead to missed diagnosis and misdiagnosis
.
Although splenic rupture is an extremely rare complication of brucellosis, vigilance
should be exercised if clinical manifestations are acute abdomen and potentially suspected infectious and inflammatory disease.
In this case, the patient emphasized the possibility of spontaneous splenomegaly rupture in acute brucellosis, the need for timely identification and immediate anti-brucellosis treatment in clinical diagnosis and treatment, and early diagnosis and management are essential
to improve the prognosis of patients with brucellosis spontaneous splenomegaly rupture.
Resources:
1.
Siraj F, Dhar A, Shabir A, et al.
(September 03, 2022) A Rare Case of Brucellosis With Spontaneous Splenic Rupture Presenting as an Acute Abdomen.
Cureus 14(9): e28753.
2.
Wang Bin, Zhu Xinguo, et al.
Diagnosis and treatment of 13 cases of spontaneous splenic rupture[J].
Tianjin Medicine,2019,47(09):962-965.
3.
Bai Xiaochen, Zeng Huihui, et al.
Clinical features of acute brucellosis in different age groups[J].
Disease Surveillance,2018,33(09):736-739.