Spontaneous spleen rupture in legionnaires' disease

Abstract text (incl. references and figure legends)

A 59-year-old male patient was admitted to the ER after a low-impact car accident subsequent to a loss of consciousness.His past medical history included dyslipidemia and HPB.At clinical examination,disorientation,fever and headache were observed.The other vital signs were within range.Blood test results showed mild leukocytosis and Hb levels at 13.2 g/L.Head CT scan,pelvic X-ray and FAST resulted negative,whilst chest X-ray showed a left upper lobe pneumonia.Legionella urinary antigen was detected positive.Hence the patient was hospitalized to the Internal Medicine Ward,where he was treated with supplemental oxygen therapy, steroids, bronchodilators and antimicrobial therapy (ceftriaxone and azithromycin, then switched to piperacillin/tazobactam and levofloxacin).After four days the patient became apyretic,and a follow-up chest CT scan was performed,showing splenomegaly.On the following day,the patient suffered from worsening abdominal pain.An emergency abdominal CT scan showed grade III spleen rupture and hemoperitoneum.Emergency laparotomy with splenectomy was performed,followed by a five-day admission in ICU.When clinical stability was achieved,the patient was transferred to the Internal Medicine ward.The patient was discharged on the 20th POD,after clinical resolution of pneumonia.Outpatient follow up after two weeks with abdominal US did not show post operative complications.Few cases of spontaneous spleen ruptures are described in literature.The mechanism of action of spontaneous spleen rupture associated with legionnaires" disease is still unknown,but it may be the result of splenomegaly,infectious state and thrombosis,resulting in spleen congestion and its rupture. We assume that the spontaneous spleen rupture was determined by the legionnaires' disease.Casanova-Roman M et al.Spontaneous rupture of the spleen associated with Legionella pneumonia.Can J Infect Dis Med Microbiol. 2010 Fall;21(3):e107-8. doi: 10.1155/2010/846419. PMID:21886641;PMCID:PMC2951811

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