A computed tomography (CT) scan of the abdomen showed a low density mass measuring 200 by 150 mm, located in the upper and middle part of the spleen with fistulae through to the stomach and abscess in the upper part of the left kidney (Figures

1 and 2). All blood and stool cultures were negative. Immunological tests for tuberculosis and human immunodeficiency virus (HIV) serology were negative. Serologic tests (enzyme-linked immunosorbent assay [ELISA] and coelectrosynerese) were also negative for hydatid cyst disease (Echinococcus granulosus) and amebiasis. Treatment with piperacillin–tazobactam (4 g tid) and amikacin Z-VAD-FMK (15 mg/kg/d) was started and surgical intervention was decided upon. The patient received pneumococcal, meningococcal, and Haemophilus b vaccinations. Splenectomy was performed through celioscopy. In addition, a 10 mm diameter gastrosplenic fistula was found, leading to partial gastrectomy. The spleen weighed 500 g and contained a large cyst and perforated gastric ulcer (20 × 10 mm). Histopathology revealed a giant splenic pseudocyst (13 × 10 5-Fluoracil purchase cm) with a wall consisting of fibrous tissue and accumulation of necrotic tissue/fluid, without an epithelial

lining. This lack of epithelial lining led to the term pseudocyst that could have been secondary to inflammation or trauma. The fluid aspirated from the spleen cystic lesion was collected for bacteriological examination. On Gram staining, there were many leukocytes, but no bacteria. After 2 days of culture, Salmonella enterica serovar enteritidis was identified. This isolate was only resistant to nalidixic acid. It was susceptible to all other indicated antibiotics. The patient was thus given amoxicillin for 7 more days. He was discharged 7 days after surgery and he fully recovered. This traveler presented with a giant splenic abscess revealing an infection by S enterica serovar enteritidis. Splenic

localization of the infection was possibly favored by a preexisting splenic cystic O-methylated flavonoid disease. In addition, diagnosis was difficult because it was abated by empiric antibiotherapy. Splenic abscesses are uncommon but severe. The overall mortality rate is estimated at 12.4%, but may be up to 25% in immunocompromised patients.3 They are usually a complication of bacteremia (49%) resulting from a focal infection such as endocarditis, dental abscess, intravenous drug abuse, or urinary tract infection. Otherwise, they are considered as contagious infections by direct extension (10% to 15%) or surinfection of cysts or hematomas (10%).3–5 In our case, the splenic localization of the abscess may be the consequence of bacteremia. About half of patients with splenic abscesses have predisposing factors: preexisting anatomic abnormalities (hematoma, cysts, pseudocysts, post-traumatic lesion) or immunocompromised status (malignancies, hematologic disorders, drug abuse, cancer chemotherapy, AIDS, transplantation).