(P24-001-25) Splenic Abscess in Enteric Fever: A Critical Insight Into an Underweight Adolescent

Objectives: Splenic abscess as a complication of typhoid fever is a distinct rarity. Notably, Salmonella species are among the primary pathogens implicated, with the incidence of splenic abscess in typhoid fever reported between 0.29-2%.(ref: Indian paediatrics journal). The advent of antibiotics has significantly reduced such complications, making splenic abscess caused by Salmonella typhi an exceedingly rare and dangerous manifestation of typhoid fever.

Methods: A 12-year-old underweight female patient presented with a 4 day history of fever, chills and vomiting, with no history of icterus or abdominal trauma.

On admission, the patient revealed signs of fever, hypotension and anaemia. Initial laboratory investigations revealed leucopenia, anaemia, thrombocytopenia, normal liver and renal function tests. HIV serology was negative. Inj Ceftriaxone, Inj Linezolid and Inj Amikacin were administered in view of the blood picture suggestive of gram negative sepsis. Patient was started on inj noradrenaline for hypotension. Blood pressure was monitored for 24 hours after drug administration till the patient was haemodynamically stable.

An abdominal ultrasound revealed a hypo-echoic collection measuring 59 x 65 x 52 mm in the spleen, suggesting a splenic abscess. Smaller cystic lesions, indicative of developing abscesses, were also identified.

Diagnostic laparoscopy and abscess drainage were performed, yielding approximately 80-100 mL of serous fluid. Cultures from the abscess revealed Salmonella typhi, sensitive to Azithromycin. The patient was transitioned to intravenous Azithromycin at 20 mg/kg/day, and her condition gradually improved. Oral azithromycin was given for a total of 14 days and linezolid for 4 weeks. Additionally, nutritional supplementation was given to the patient.

Results: Paediatric patients who are malnourished may represent a particularly vulnerable group. Malnutrition leaves the patients with lowered immunity making them more prone and vulnerable to life threatening infections such as splenic abscess.

Conclusions: Immunodeficiency is one of the main pathogenic factor of splenic abscess. Immune functions can be restored with adequate and appropriate nutrition. Though not a primary source of treatment, proper nutrition plays a supportive role in the management of splenic abscess.

Funding Sources: None