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Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing
Piseth Seng, Fanny Quenard, Amélie Menard, Laurent Heyries, Andreas Stein
To cite this version:
Piseth Seng, Fanny Quenard, Amélie Menard, Laurent Heyries, Andreas Stein. Campylobacter jejuni,
an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing. International Journal
of Infectious Diseases, Elsevier, 2014, 29, pp.238-240 �10.1016/j.ijid.2014.09.014�. �hal-01240345�
Case Report
Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing
Piseth Seng
a,b,*, Fanny Quenard
a, Ame´lie Menard
a, Laurent Heyries
c, Andreas Stein
a,baServicedeMaladiesInfectieuses,CentreInterre´gionaldeRe´fe´rencedesInfectionsOste´o-articulairesMe´diterrane´eSud,CHUdelaConception,Assistance Publique–HoˆpitauxdeMarseille,147,boulevardBaille,Marseille,France
bAixMarseilleUniversite´,Marseille,France
cServiced’He´pato-Gastro-Ente´rologie,CHUdelaConception,AssistancePublique–HoˆpitauxdeMarseille,Marseille,France
1. Introduction
Splenicabscessisrarethatmaybemisdiagnosedbecauseofthe existenceofmisleadingorformswithantibioticsdecapitated.1,2 Wereportedheredescribedthefirstcaseofaspontaneoussplenic abscesscausedbyCampylobacterjejuniasdeterminedby16SrRNA genesequencinginanimmunocompetentpatient.
2. Casereport
InMay2013,a20-year-oldCaucasianmanwasadmittedtothe infectious disease department of the university hospital in Marseilleforsevereupperleftquadrantpainthathadappeared 4daysafterfebrilediarrhea.Priortothediarrhea,hehadbeenwell, withnothingnotable inhis medical history. Hehad not had a splenictraumaorcontactwithanimals,andhehadnottraveledto a tropicalarea. Hisbody temperaturewas398C, hispulse was 113 beats/min, and his blood pressure was 100/59mmHg.
Laboratory investigations revealed pathological values for
C-reactiveprotein(266mg/l;normalvalues5mg/l)andfibrino- genlevels(7.7g/l;normalvalues1.8–4g/l),anelevatedleukocyte count(18109/l,predominantlyneutrophilgranulocytes),alow hemoglobin concentration (116g/l; normal 135–175g/l), and a normalplateletcount(339109/l).Resultsofserumelectropho- resis were normal. A computed tomography (CT) scan of the abdomen revealed an 11-cm splenic abscess with peripheral calcificationsand aperi-spleniccollectionassociatedwitha left pleural effusion (Figure 1a). 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT)showedaunilocularspleniccollectionwithhypometa- bolicactivity (Figure1b). Repeatblood cultures werenegative.
StoolculturestoassayforSalmonella,Shigella,Campylobacter,and Yersinia specieswere negative.Indirecthemagglutination (IHA) andELISAtestsforEntamoebahistolyticawerenegative.Transtho- racicechocardiographywasnegativeforinfectiveendocarditisand valveabnormalities.
Empiricalantibiotictreatmentwithceftriaxone andmetroni- dazolewasstarted.Nevertheless,a fever(upto408C)persisted after1weekoftreatment,atwhichtimethesplenicabscesswas percutaneously drained and 1200ml of purulent fluid was aspirated.After drainageofthesplenic abscess,thepatienthad definitive apyrexia. Bacterial cultures of the deepsample were InternationalJournalofInfectiousDiseases29(2014)238–240
ARTICLE INFO
Articlehistory:
Received27August2014
Receivedinrevisedform23September2014 Accepted24September2014
CorrespondingEditor:EskildPetersen, Aarhus,Denmark
Keywords:
Splenicabscess Campylobacterjejuni Intragastricdrainage FDG-PETscan
16SrRNAgenesequencing Splenectomy
SUMMARY
Splenicabscessisararediseasethatprimarilyoccursinpatientswithsplenictrauma,endocarditis,sickle cellanemia,orotherdiseasesthatcompromisetheimmunesystem.Thisreportdescribesaculture- negativesplenicabscessinanimmunocompetentpatientcausedbyCampylobacterjejuni,asdetermined by16SrRNAgenesequencing.
ß2014TheAuthors.PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases.
ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by- nc-nd/3.0/).
* Correspondingauthor.Tel.:+33(0)491384124;fax:+33(0)491382041.
E-mailaddress:[email protected](P.Seng).
ContentslistsavailableatScienceDirect
International Journal of Infectious Diseases
j o urn a l hom e pa ge : ww w. e l s e v i e r. c om/ l o ca t e / i j i d
http://dx.doi.org/10.1016/j.ijid.2014.09.014
1201-9712/ß2014TheAuthors.PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/3.0/).
negative. Histology performed on the liquid confirmed the presenceofa pyogenicsplenic abscess,and 16SrRNAPCR was positiveforCampylobacterjejuni.Thepatientwasdischargedon day15ofhospitalization.
Post-discharge, the patient was given a 6-weektreatment of ceftriaxone.Duringantibiotictreatmentand1monthafterpercuta- neousdrainage,thespleniccollectionrelapsedwithoutanyclinical symptoms.This was drainedunder endo-ultrasonography in the stomachviatwodouble-pigtailstents. ACT scan9monthsafter intragastric drainage revealed a 5-cm splenic collection with calcification sequelae but no peri-splenic collection or pleural effusion(Figure1c).Thetwodouble-pigtailcatheterswereremoved at10months,andnorelapses wereobservedatthe 1-yearpost- antibioticfollow-up.
3. Discussion
Inthisreport,wedescribethefirstcaseofaspontaneoussplenic abscess caused by C. jejuni in an immunocompetent patient.
Pyogenicsplenicabscessisadiseasethatisrarelyreported.1The predisposingfactorsthatarefrequentlyrecordedaresplenictrauma, endocarditis, intravenous drug use, sickle cell disease, diabetes mellitus, andcongenital or acquired immunodeficiency.1 In this case,thesplenicabscesswasdiagnosedbythepresenceoffeverand painintheupperleftquadrantoftheimmunocompetentpatient after 4 daysof diarrhea and fever,without a splenic traumaor metastaticinfectionarisingfromendocarditisoraprimaryabscess.
Asplenicabscessmaybemisdiagnosedbecauseofnon-specific clinicalsigns.Thetypicalsymptomsoffever,upperleftquadrant pain,splenomegaly,andleftpleuraleffusionarefoundinonly84–
95%of cases,39–50%ofcases, 30–67%ofcases,and 19–41%of cases, respectively.1 Nonetheless, modern imaging techniques, suchasabdominalCTscans2andPET/CTscans,haveenhancedthe diagnosticprocess.In ourcase, CTand PET/CTscans confirmed
thediagnosisofsplenicabscessandallowedustoexcludeother localizationsofC.jejuniinfection.
Mostsplenicabscessesareduetoasingleorganism,2andthe main causal microorganisms identified in splenic abscesses are Streptococcusspp,Staphylococcusspp,Salmonellaspp,Escherichiacoli, Klebsiellapneumoniae,Proteusmirabilis,Pseudomonasspp,Mycobac- teriumspp,andsomeanaerobicbacteria.1,2Inourcase,bloodand stool cultures prior to antibiotic treatment were negative for Salmonella, Shigella, Campylobacter, and Yersinia species. The diagnosis of C. jejuni infection was obtained by 16SrRNA gene PCR amplification and sequencing of culture-negative splenic abscessdrainagefluidobtained1weekafterantibiotictreatment.
The mostcommon humaninfections causedby C.jejuni are gastrointestinalinfections, which are typically characterized by diarrhea,fever,andabdominalpain.3Extra-digestiveinfectionsare quiterare;casesofGuillain–Barre´ syndrome,acutecholecystitis, meningitis, pneumonia, urinary tract infection, thoracic wall abscess, arthritis, endocarditis, and transient bacteremia have occasionallybeenreported.3,4Toourknowledge,thecasereported here is the first of a splenic abscess caused by C. jejuni in an immunocompetentpatient.
There is no gold standard for treating splenic abscesses. A splenectomyhaslongbeenconsideredtobetheprincipaltreatment forasplenicabscess.1However,foryoungpatients,percutaneous drainageofasplenicabscessfollowedbyantibiotictreatmentisan alternative to splenectomy.2 Antibiotictreatment alone without drainageofthepyogenicsplenicabscesshasbeenproposedbysome authors.1Intragastricdrainageofasplenicabscesswithtwodouble- pigtail catheters has been used in cases of splenic abscess complicatedbypancreatitis5orgastrosplenicfistula.2
Inthiscase,weperformedpercutaneousdrainageandtreated the patient with broad-spectrum antibiotics for 6 weeks. The splenic abscess was drained again 1 month later using an intragastric drainage procedure involving two double-pigtail stents.
Figure1.(a)CTscanoftheabdomenshowingan11-cmunilocularsplenicabscess.(b)FDG-PETscanshowingaunilocularspleniccollectionwithhypometabolicactivity.(c) CTscanoftheabdomenshowingcalcificationsequelaeinthespleenat12monthsaftertheendoftreatment.
P.Sengetal./InternationalJournalofInfectiousDiseases29(2014)238–240 239
Insummary,ourcasehighlightsanuncommonsplenicabscess causedbyC.jejunithatappearedinayoungpatientwhodidnot haveanimmunedeficiencyorsplenictrauma.Theinfectionwas managedsuccessfullywithpercutaneousandintragastricdrainage combinedwithaprolongedcourseofantibiotictherapy.
Ethicalapproval:Thisstudywasapprovedbytheinstitutional researchethicsboardandwritteninformedconsentwasobtained fromthepatient.
Funding:Theauthorshavenorelevantaffiliationsorinvolve- mentwithanyorganizationorentitywithafinancialinterestor conflict with the subject matter or materials discussed in the manuscript.Nowritingassistancewasutilizedintheproductionof thismanuscript.
Conflictofinterest:Theauthorsdeclarenoconflictsofinterest.
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