The incidence of splenic abscesses is currently 0.14-0.7% with a reported mortality of 0-47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs) and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550) and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants), respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.
It seems that 5 days is a too short period for development od a splenic abscess of such proportions. It is probably not related to the PCI procedure.
i don't think that antibiotic prophylaxis should be recommended for PCI
Yes, it looks as parallel events (not related or even imitate heart attack). Antibiotic prophylaxis (and prolonged therapy) is absolutely indicated for partial splenic embolization-PSE (according to our experience), about PCI - I am not sure. Splenic abscess formation time (1 case of 130 RI operations of SAE/PSE) > 10d.
I agree with the previous comments, the abscess maybe was not related to PCI. Giving antibiotic prophylaxis in PCI would increase antibiotic pressure and generate even more resistent strains in your area.
Interesting observation,I do agree with above researchers that it takes time and takes some more time to rupture.I feel that a health check up including u/s scan would have cleared this puzzle !
I dont think there is any relationship between PCI and splenic abscess unless the patient already had for example an atrial fibrilation therefore there is no reason for antibiotic administration in PCI patients
It is of course true that cardiac catheterization carries a negligible risk of bacteremia but with PCI bacteremia occurs frequently (in approximately 30% of cases); however, clinical sequelae occur rarely in such cases. PCI has a greater bacteremic potential, probably because of the length of the procedure and the repeated insertion of interventional devices into the vascular system . Infective mycotic aneurysm presenting as transient acute coronary occlusion and infectious pericarditis [Badshah A, Younas F, Janjua MSouth Med J. 2009 Jun; 102(6):640-2.]
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