Sars-Cov2 as a possible origin of spontaneous splenic rupture in a patient admitted to the critical care unit

Abstract text (incl. references and figure legends)

Many symptoms have been related with COVID infection:respiratory,digestive,immunologic, prothrombotic(1)Trauma is the most usual cause of splenic rupture.Spontaneous rupture is rare and related to neoplasms and infections(malaria,HHV-4).(2)(3)

Sars-Cov2 tropism towards the spleen is widely known so though prothrombotic and immune dysregulation make plausible an spontaneous splenic rupture in this context.(4)(5)

Acute abdomen due to splenic rupture is a surgical challenge:arterial embolization or urgent splenectomy could be needed.

We present a patient admitted to ICU, intubated due to COVID pneumonia with posterior hemodynamic deterioration secondary to spontaneous splenic rupture.

Clinical Case:A 72 years male tourist with historial of hypertension and diabetes, vaccinated against SARSCov-2. Admitted to ICU for Covid19 bilateral pneumonia, requiring intubation and anticoagulation.On 17th day of admission he suffered a sudden hemodynamic deterioration.The CT scan showed pulmonary ground glass consolidations with splenic subcapsular hematoma and hemoperitoneum with no active bleeding.An urgent splenectomy was performed due to persistent hemodynamic instability despite resuscitation,polytransfusion and amines.Pathology exam showed 4.5cm capsular laceration with parenchymal exposure without other findings. Arrangements were made to transfer the patient to his country to continue intensive treatment.

Conclussion:

Proinflammatory and prothrombotic cytokines altere the splenic functionality and structure. We hypothesise that this dysregulation is the cause of spontaneous rupture, as occurs in other splenotrophic viruses.

In case of inestability spleenectomy is mandatory.Embolization is used in those who respond to resuscitation without active bleeding.Surgery in Covid+ patients have higher morbimortality and complications.

We believe that in case of abrupt hemodynamic deterioration in Covid+ patients, spontaneous splenic rupture should be taken into consideration

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