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Splenic rupture as the presenting symptom in infective endocarditis: a rare and dangerous complication
  1. Gautam Sen1 and
  2. Susan Lewis2
  1. 1Cardiology, King's College NHS Foundation Trust, London, UK
  2. 2Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
  1. Correspondence to Dr Gautam Sen; gautamsen{at}nhs.net

Abstract

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.

  • valvar diseases
  • infections
  • cardiothoracic surgery

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Footnotes

  • Contributors Both authors were directly involved in the patient’s care and contributed to the creation of this article. GS and SL both wrote and drafted the document, the images and processed the videos. GS is the lead and corresponding author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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