Microsoft Word - NEF255BF


Takamichi Nakamura, MD, The Second Department of Medicine, Yamanashi Medical School, Yamanashi 409-38 (Japan) Dear Sir, A splenic abscess is an unusual condition seen in immunocompromized patients or associated with intravenous drug abuse [1]. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess [1]. Splenic abscesses have not been reported in hemodialysis patients without any of these predisposing factors reported previously [1], although 2 hemodialysis patients with diabetes mellitus or immunosuppressive therapy were reported to develop splenic abscesses acquired through access site infection [2]. A 36-year-old man who had been on hemodialysis for 3 years was admitted with left hypochondralgia and fever. There was no history of trauma, blood access site infection, diabetes mellitus or immunosuppressive therapy. Nine years previously, he had had hematuria, proteinuria and hypertension. Renal biopsy confirmed mesangial proliferative glomerulonephritis. Over the next 6 years, he progressed to end-stage renal failure. After 3 years of maintenance hemodialysis, he had general fatigue and fever. He was treated with antibiotics (MINO, ENX, CXD, CEZ), since leukocytosis was found at the hemodialysis clinic. The symptoms did not respond to these antibiotics, and he was transferred to the renal unit in our hospital. On examination, there was tenderness in the left hypochondrium. There was no sign of hepatomegaly or ascites. There was no infected needle site related with A-V fistula. The white blood cell count was 26,300/mm3 with a severe left shift. Hb was 9.3 g/dl. ESR was 117/161 mm. CRP was 6 + . S-GOT, S-GPT, AI-P and LDH were normal. Chest X ray was normal. An ultrasound scan showed multiple hypoechoic lesions in the spleen (fig. la), and normal findings in liver, gallbladder and kidney. A computed tomography also showed multiple nonenhanced low density lesions in spleen (fig. lb), and normal findings in other intra-abdominal organs. No organism was grown from the blood. As shown in figure 2, he was treated with latamoxef (LMOX) for 8 days sequentially, and the fever resolved. Subsequently, he was treated with LMOX only after hemodialysis. An ultrasound scan examination revealed that the splenic abscess was getting smaller and finally resolved on the 30th hospital day. Antibiotic therapy was stopped when the ultrasound scan examination and

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@inproceedings{Nephron2008MicrosoftW, title={Microsoft Word - NEF255BF}, author={Nephron and Takamichi Nakamura and Akira Iwashima and Terasu Honma and Norio Higuma and Kohji Tamura}, year={2008} }