Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency

Min Yong Park,Jung A Kim,Seong Yoon Yi,Sun Hee Chang,엄태현,이혜란 대한혈액학회 2011 Blood Research Vol.46 No.4

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.

저혈압성 비장 경색: 증례 보고

한수봉,박원규,장재천,조재호 대한영상의학회 2007 대한영상의학회지 Vol.57 No.5

Splenic infarction occurs when parenchymal ischemia of the spleen is evoked by an occlusion of the arterial or venous circulation. The most common causes include infiltrative hematological disease and thromboembolic conditions, but a hypotensive splenic infarction may be a rare cause of splenic infarction. A 62-year-old female patient presented with a hypotensive splenic infarction after massive bleeding. CT showed geographic low-density lesions in the central part of the spleen on the tissue equilibrium phase of dynamic CT. Usually, a depressed scar occurs in the course of healing of a splenic infarction. However, in this case recovery of blood flow and regeneration of the infarcted spleen was seen during the follow-up CT scans. We report a case of hypotensive splenic infarction with a review of the literature. 비장경색은 동맥 혹은 정맥 순환이 막혔을 때 비장 실질의 허혈에 의해 일어난다. 가장 흔한 원인으로는 침윤성 혈액장애와 큰 혈관의 폐색을 일으키는 혈전색전에 의한 상태가 있지만 저혈압성 비장경색도 드물게 일어날 수 있다. 62세 여자환자가 대량 출혈 후에 저혈압성 비장경색증이 발생하였다. CT에서 비장의 중심부에 지도형의 저음영 병변이 동맥기 강조영상과 조직평형기 영상에서 관찰되었다. 일반적으로 비장경색의 회복 과정에서는 흔적이 남게 된다. 하지만, 우리 증례에서는 추적검사를 하는 동안 혈류의 회복과 비장의 재생을 보여주었다. 저자들은 저혈압성 비장경색에 대한 1예를 문헌 고찰과 더불어 보고하고자 한다.

전신홍반루푸스의 비장경색으로 처음 발현된 항인지질 증후군

정혜윤 ( Hye Yun Jeong ),강산하 ( San Ha Kang ),송지현 ( Ji Hyun Song ),신선영 ( Sun Young Shin ),민다니엘 ( Daniel Min ),한규현 ( Kyu Hyun Han ),최진정 ( Jin Jung Choi ) 대한내과학회 2014 대한내과학회지 Vol.86 No.5

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In patients with SLE, the prevalence of antiphospholipid antibodies is considerably higher, and is largely responsible for thrombosis. Splenic infarction is a rare complication of arterial thrombosis in patients with SLE. It is important to consider splenic infarction in a patient with SLE complaining of left upper quadrant (LUQ) pain because of the possibility of severe infarction-related complications, such as subcapsular hemorrhage and splenic rupture. We report a case of solitary splenic infarction in a patient with SLE. The only symptom was LUQ pain of 3-day duration. Lupus anticoagulant activity was positive and abdominal-pelvic computed tomography (CT) was consistent with splenic infarction. She did not show any other evidence of thrombotic events. The patient was diagnosed with antiphospholipid syndrome that presented as a splenic infarction in a SLE patient. (Korean J Med 2014;86:651-654)

위정맥류 출혈과 비장경색을 합병한 만성췌장염

문윤기(Yoon Gi Moon),이보인(Bo In Lee),강성호(Sung Ho Kang),양영상(Young Sang Yang),채현석(Hyun Suk Chae),최규용(Gyu Yong choi),정인식(In Sik Chung),차상복(Sang Bok Cha),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

Splenic infarction is an uncommon form of splenic pathology. It occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Other etiologic factors include splenic vascular disease, anatomic abnormalities, collagen vascular disease, nonhematologic malignancy, and pancreatic disease in the extremely rare form. Pancreatic disease may result in splenic infarction because of constriction of the splenic vessels by the fibrotic pancreas, tortuous aneurysm, or thrombosis of splenic vein. A pseudocyst in the tail of the pancreas may dissect into the hilum, causing vascular compromise and infarction. Recently we experienced a 47-year old man cpmplaining of left upper quadrant pain, which was diagnosed as gastric variceal bleeding and splenic infarction associated with chronic fibrosing pancreatitis confirmed by ultrasonogram of abdomen, abdominal CT, angiography, and operation. Distal pancreatectomy and splenectomy were performed, and subsidence of his symptoms was observed. We report this case with a review of the relevant literature. (Korean J Gastroenterol 1995;27:611 - 616)

항인지질 증후군과 연관된 급성 췌장염 및 비장 괴사 1예

고경현 ( Kyung Hyun Koh ),강창준 ( Chang Joon Kang ),김동훈 ( Dong Hoon Kim ),최용원 ( Yong Won Choi ),황재철 ( Jae Chul Hwang ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.1

There are various causes of splenic infarction. Antiphospholipid antibody is associated with numerous thromboembolic phenomena. We report a case of young male who presented with acute abdominal pain and was diagnosed as a case of splenic infarction and acute pancreatitis with antiphospholid syndrome. He was positive for anti-cardiolipin antibody, showed splenic infarction on abdominal CT scan. The patient`s clinical, laboratory and imaging finding were consistent with splenic infarction and acute pancreatitis associated with antiphospholipid syndrome. (Korean J Gastroenterol 2009;53:57-59)

전신성 홍반성 루푸스에 동반된 단독성 비장경색

서주현 ( Ju Hyun Suh ),박원 ( Won Park ),박보형 ( Bo Hyoung Park ),김성수 ( Sung Soo Kim ),이용환 ( Yong Hwan Lee ),송정수 ( Jung Soo Song ),최원식 ( Won Sick Choe ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Systemic lupus erythematosus (SLE) is a multisystemic inflammatory autoimmune disease caused by various autoantibodies and immune complexes. Splenic involvement in SLE includes hypersplenism, splenic atrophy, and splenic infarction, which has rarely been reported. We report a case of SLE with isolated splenic infarction. A 20-year-old female patient was admitted complaining of general weakness, malar rash, and easy fatigue. She was diagnosed as having SLE with thrombocytopenia and received steroid treatment. On the 7th hospital day, she complained of severe left upper abdominal pain with sudden-onset. While abdominal ultrasonography showed only mild splenomegaly, abdominal CT and 99mTc-RBC splenic scintigraphy revealed segmental splenic infarction. She had no evidence of additional thrombotic event or hemorrhage. After administration of high dose steroid, abdominal pain subsided and splenic infarction was resolved.

Spontaneous Celiac Artery Dissection with Splenic Infarction: A Report of Two Cases

Suh Min Kim,Hyunmin Ko 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.3

Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that is characterized by sudden onset abdominal pain, typically occurring in middle-aged men. Although its clinical course is mostly benign, it may progress to true lumen occlusion. No established therapeutic guidelines are available for SICAD associated with splenic infarction. This report describes two patients who presented with sudden onset abdominal pain and were diagnosed with SICAD with splenic infarction based on computed tomography (CT) findings. Patients were treated with bowel rest and anticoagulants. After a week of medical therapy, the abdominal pain resolved. Follow-up CT revealed no progression of the dissection flap. The patients received oral anticoagulants for 3 months and did not experience any symptom recurrence. Medical therapy with anticoagulants may be considered for patients with SICAD and splenic infarction. Associated splenic infarction itself is not an indication for endovascular or surgical intervention for SICAD.

Splenic Infarction Associated with Brucellosis in a Non-Endemic Area

이재훈,이유민,이창훈,최창수,김태현 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.1

A 45-year-old man was referred from a local clinic with persistent fever, intermittent pain in the left upper abdomen, and weight loss of 7 kg. He quit his animal husbandry 18 months ago when his cows were found to be infected with Brucella. Abdominal computed tomography (CT) scan taken on admission showed splenomegaly with a wedge-shaped hypoattenuating region in the enhanced image, which was consistent with splenic infarction. Serology for Bruculla was strongly positive with the standard tube agglutination test (1/2560). After initiation of doxycycline (100 mg every 12 hrs) and rifampin (600 mg every day), the patient’s condition improved, and was discharged with oral antibiotics that were to be continued for 3 months. During the 12 months’ follow up at the outpatient department, the patient had no symptoms, and the last agglutination titer for Brucella in serum had decreased to 1/40. To our knowledge, this is the first report on splenic infarction associated with brucellosis in Korea, which was treated successfully with antibiotic therapy.

비장 경색을 동반한 브루셀라증 1례

이재훈,이유민,이창훈,최창수,김태현 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

A 45-year-old man was referred from a local clinic with persistent fever, intermittent pain in the left upper abdomen, and weight loss of 7 kg. He quit his animal husbandry 18 months ago when his cows were found to be infected with Brucella. Abdominal computed tomography (CT) scan taken on admission showed splenomegaly with a wedge-shaped hypoattenuating region in the enhanced image, which was consistent with splenic infarction. Serology for Bruculla was strongly positive with the standard tube agglutination test (1/2560). After initiation of doxycycline (100 mg every 12 hrs) and rifampin (600 mg every day), the patient’s condition improved, and was discharged with oral antibiotics that were to be continued for 3 months. During the 12 months’ follow up at the outpatient department, the patient had no symptoms, and the last agglutination titer for Brucella in serum had decreased to 1/40. To our knowledge, this is the first report on splenic infarction associated with brucellosis in Korea, which was treated successfully with antibiotic therapy.

기저질환이 없는 건강한 성인에서 발생한 비장경색증을 동반한 양측성 신경색증

주강 ( Ju Gang ),한창희 ( Han Chang Hui ),김기태 ( Kim Gi Tae ),장석태 ( Jang Seog Tae ),김현진 ( Kim Hyeon Jin ),김영수 ( Kim Yeong Su ),윤선애 ( Yun Seon Ae ),김영옥 ( Kim Yeong Og ),장윤식 ( Jang Yun Sig ),방병기 ( Bang Byeong 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2

Renal infarction usually occurs in patients with cardiovascular disease or commective tissue disease. But it rarely occurs in a healthy person without any underlying diseases. Here we report a case of idiopathic bilateral renal and splenic infarctions in a healthy person. A 31-year-old man was admitted because of sudden onset of both flank and diffuse abdominal pain. He had experienced same flank and abdominal pains ten days ago. He had no medical history of hypertension, heart disease, diabetes, and renal disease. He also denied history of abdominal trauma and drug ingestion. Abdominal computed tomography revealed bilateral renal infarction and concomitant splenic infarction. Both renal arteriography also demonstrated obstruction of left anterior branch and marked narrowing of right anterior branch. Electrocardiography and echocardiography were all normal. There was no evidence of systemic lupus erythematosus, antiphospholipid syndrome, and any hypercoagulable state. (Korean J Nephrol 2004;23(2):341-344)