Abstract
A 64-year-old man with a history of chronic lymphocytic leukemia (CLL) presented in the hematology department due to remarkable leukocytosis and progressing anemia. Ultrasound confirmed splenomegaly and plain computed tomography revealed multiple hypoattenuating areas in the large spleen. Following a clinical diagnosis of relapse of CLL, he underwent treatment with fludarabine, cyclophosphamide, and rituximab (FC-R). After five cycles of FC-R treatment, his leukocyte count and hemoglobin level were normalized, and the size of the spleen also decreased. He began to have intermittent high fever (38 °C), however, approximately 6 months after the initiation of FC-R treatment. The results of an interferon-gamma release assay were positive. 18F-fluoro-2-deoxy-d-glucose positron emission tomography showed multiple areas of high-uptake in the spleen, which was unclear in other radiologic modalities. We performed a splenectomy for the high fever and to confirm the diagnosis. Tissue cultures of the infarcted area of spleen were positive for Propionibacterium acnes. After splenectomy, the patient’s condition improved and there were no further episodes of fever. Until recently, three cases of splenic abscess caused by Propionibacterium acnes were reported. Here we present a fourth case of splenic abscess due to Propionibacterium acnes and review the literature.
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Acknowledgments
The authors would like to thank Masako Sugimoto, Yasuhiko Kamikubo, Mineo Kurokawa of Department of Hematology, Graduate School of Medicine, The University of Tokyo, Yukako Shintani, Masashi Fukayama of Department of Pathology, Graduate School of Medicine, The University of Tokyo, Junichi Shindoh, Yoshikuni Kawaguchi, Kiyohiko Omichi, Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo for their important contributions to the diagnosis.
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Conflict of Interest: The authors declare that they have no conflict of interest.
Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).
Informed Consent: Informed consent was obtained from all patients for being included in the study.
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Kiritani, S., Kaneko, J., Aoki, T. et al. Multiple splenic nodules with fever: a case of splenic abscess due to Propionibacterium acnes . Clin J Gastroenterol 6, 434–437 (2013). https://doi.org/10.1007/s12328-013-0427-5
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DOI: https://doi.org/10.1007/s12328-013-0427-5