1
|
Gligorijevic N, Kaljevic M, Radovanovic N, Jovanovic F, Joksimovic B, Singh S, Dumic I. Adrenal Abscesses: A Systematic Review of the Literature. J Clin Med 2023; 12:4601. [PMID: 37510716 PMCID: PMC10380332 DOI: 10.3390/jcm12144601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Objective: To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. Design: Systematic literature review. Methods: We performed a search in the PubMed database using search terms: 'abscess and adrenal glands', 'adrenalitis', 'infection and adrenal gland', 'adrenal abscess', 'adrenal infection' and 'infectious adrenalitis'. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. Results: Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with Histoplasma capsulatum (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (p = 0.048). Conclusion: Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, Histoplasma capsulatum is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder.
Collapse
Affiliation(s)
- Nikola Gligorijevic
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marija Kaljevic
- Department of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, USA
- Division of Internal Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Natasa Radovanovic
- Department of Endocrinology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Filip Jovanovic
- Department of Internal Medicine, Merit Health Wesley, Hattiesburg, MS 39402, USA
| | - Bojan Joksimovic
- Department of Pathological Physiology, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Sandra Singh
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| |
Collapse
|
2
|
Yang Y, Liu J, Zheng Z, Tang C, Zhu D, Xia X, Huang L, Du Q, Hao Y, Liu Y, Jin Z. Case report: a case of multiple splenic abscesses in a child and literature review. Front Pediatr 2023; 11:1162527. [PMID: 37215587 PMCID: PMC10196135 DOI: 10.3389/fped.2023.1162527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Splenic abscesses in children are very rare, and multiple splenic abscesses are rarer. These lesions are difficult to diagnose quickly because of their low incidence and the low specificity of the associated clinical and imaging findings. The treatment of splenic abscesses includes conservative treatment, percutaneous drainage, and splenectomy, but the selection criteria for treatment are still unclear. We present a case of a 13-year-old girl with multiple splenic abscesses. Her blood culture report was negative. We eventually confirmed the diagnosis by enhanced magnetic resonance imaging (MRI). The patient underwent a successful laparoscopic total splenectomy, and her symptoms were resolved thereafter.
Collapse
Affiliation(s)
- Yingchun Yang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Jian Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Zebing Zheng
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Chengyan Tang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Daiwei Zhu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Xingrong Xia
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Lu Huang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Qing Du
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Yongxing Hao
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Yuanmei Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| | - Zhu Jin
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatric Surgery, Guizhou Children Hospital, Zunyi, China
| |
Collapse
|
3
|
Rasslan R, Alves V, Damous SHB, de Santis A, Tarasoutchi F, Menegozzo CAM, Akamine M, Rasslan S, Utiyama EM. Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil. J INVEST SURG 2022; 35:1836-1840. [PMID: 36202396 DOI: 10.1080/08941939.2022.2130481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
INTRODUCTION Splenic abscess secondary to endocarditis is a rare complication with high mortality. The treatment modality, splenectomy versus percutaneous drainage, and the best time, before or after valve replacement, are controversial. In the literature, there are only a few small case series about the subject. The objective of this study is to analyze the experience of a referral center in treating such condition. METHODS Patients with splenic abscesses due to endocarditis from 2006 to 2020 were retrospectively analyzed. RESULTS Thirteen patients (mean age 46 years old, 69% male) were identified. Eight patients (62%) had at least 2 comorbidities and 5 (38%) had a history of cardiac surgery. The diagnosis was incidental in 6 (46%). The mean time of abscess diagnosis after endocarditis definition was 14 days. Six patients (46%) had at least two organ dysfunctions. The median APACHE II score was 12 overall, and 24.5 in patients who died. Six patients (46%) had a valve replacement, and in two the abscess was diagnosed postoperatively. Of the other four patients, splenectomy was performed before the cardiac operation in three and at the same time in one. Splenectomy was performed immediately in 9 (69%) patients while three patients had percutaneous drainage (23%), one of which underwent splenectomy due to drainage failure. Exclusive antibiotic treatment was performed on only one patient. The median length of hospitalization was 24 days and mortality was 46%. CONCLUSION Splenic abscess due to endocarditis is a life-threatening condition with controversial treatment that results in a prolonged length of stay and high mortality.
Collapse
Affiliation(s)
- Roberto Rasslan
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Vinicios Alves
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Sergio Henrique Bastos Damous
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Antonio de Santis
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Flavio Tarasoutchi
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Calos Augusto Metidieri Menegozzo
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Masahiko Akamine
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Samir Rasslan
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Edivaldo Massazo Utiyama
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| |
Collapse
|
4
|
Radcliffe C, Tang Z, Gisriel SD, Grant M. Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series. Open Forum Infect Dis 2022; 9:ofac085. [PMID: 35299986 PMCID: PMC8923382 DOI: 10.1093/ofid/ofac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Splenic abscess is a rare infection often resulting from hematogenous spread. Immunocompromised states are commonly comorbid, and the microbiology is heterogeneous. Methods We conducted a retrospective review of 33 cases identified by convenience sampling. Cases were treated in our institution’s hospital system between May 2012 and February 2021 and classified as proven or probable based on predetermined criteria. Results The median age was 57 years, and 58% were men. Common underlying diseases included diabetes mellitus (30%), pancreatic disease (30%), and hematological malignancy (15%). The most common mechanism of pathogenesis was hematogenous spread (n = 13). Escherichia coli, enterococcal spp., and anaerobes were frequently implicated. One case was discovered at autopsy and excluded from subsequent analyses. The median duration of antimicrobial therapy (range) was 45 (5–525) days, and the median length of index hospitalization was 20 days. Percutaneous drainage by interventional radiology was common (17 of 32; 53%), and 6 patients underwent splenectomy. Treatment success was achieved in 14 of 32 cases (44%), with clinical stability in 3 of 32 cases (9%). Failures occurred in 13 of 32 (41%) cases, 2 of whom died from splenic abscesses. Two patients (2 of 32) were lost to follow-up. Conclusions To our knowledge, this is the largest North American series since the turn of the century and the first to distinguish between proven and probable cases. As reflected in our series, patients with splenic abscess may require prolonged hospitalizations and courses of antimicrobial therapy. Improvements in management are needed.
Collapse
Affiliation(s)
| | - Zeyu Tang
- Yale University School of Medicine, New Haven, CT USA
| | - Savanah D Gisriel
- Department of Pathology, Yale University School of Medicine, New Haven, CT USA
| | - Matthew Grant
- Yale University School of Medicine, New Haven, CT USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT USA
| |
Collapse
|