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Case reports

Splenic rupture as a presenting feature of endocarditis

^a Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, Queensland, 4032, Australia
^b Department of Infectious Diseases, The Prince Charles Hospital, Chermside, Queensland, 4032, Australia

Received 14 November 2008; received in revised form 21 December 2008; accepted 27 December 2008.

^_* Corresponding author. Tel.: +61 731394000; fax: +61 731395575. (Email: james.winearls{at}doctors.org.uk).

We describe the first case of infective endocarditis presenting with spontaneous splenic rupture. Our patient, a known intravenous drug user presented with hypovolaemic shock secondary to splenic rupture. The patient was resuscitated and underwent an emergency splenectomy. Subsequent clinical examination revealed a systolic murmur and a diagnosis of mitral valve infective endocarditis was made after echocardiography. Splenic tissue, blood cultures and mitral valve tissue all cultured Enterococcus faecalis. The patient had a successful mitral valve replacement and was discharged home after 44 days. To our knowledge this is the first reported case of enterococcal endocarditis presenting with splenic rupture. This case highlights the need to consider endocarditis in spontaneous splenic rupture particularly in those patients in a high risk group, such as IV drug users, especially if they lack a clear history of trauma.

Key Words: Splenic rupture • Infective endocarditis • Enterococcus faecalis

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