Splenic infarction revealing infectious endocarditis in a pregnant woman: About a case and brief literature review

Abstract

The diagnosis of splenic infarction is rarely reported in pregnant women. Current incidence of splenic infarction, especially during infectious endocardites as well as diagnostic methods used are poorly specified in the literature. We here report the case of a 26-year old woman with no particular previous history or cardiovascular risk factor who, at the end 14 weeks of amenorrhea, presented to the Emergency Department with febrile syndrome evolving over 10 days and abdominal pain of recent onset at the level of the left hypochondre. Clinical examination showed febrile patient with a temperature of 39.5°C, tenderness of the left hypochondre and panaritium at the level of the palm of the left hand and of the sole of the foot. Gynecological examination was strictly normal. Given this clinical picture, abdominal ultrasound showed mediosplenic anechoic area with hilar apex and with peripheral edges, suggesting splenic infarct. Etiological assessment included echocardiography showing thickened and remodeled oslerian graft on the mitral valve with large valve vegetation and MI grade II. Blood cultures were performed during the febrile peaks and were positive for golden staph. Patient’s evolution was marked by the occurrence of large ischemic stroke and worsening of neurological condition, leading to death after several systemic emboli. Splenic infarction in a pregnant woman is very rare. However, clinical and radiological examination of the spleen must be performed in patients with acute abdominal pain of the left hypochondre. In the present case, pain of the left hypochondre associated with fever and Osler’s false whitlow was found to be splenic infarction associated with infectious endocarditis. Probabilistic antibiotic therapy as first-line therapy is justified during infective endocarditis and should be secondarily adapted to the bacteriological results. Although rare, splenic infarction can have severe consequences such as abscesses or rupture, which must encourage vigilance.