Document Type : Case Report(s)

Authors

• Mohammadmoein Mokhtarezadeh ¹
• Mehran Karimi ²
• Mohammad Hossein Ahrar ³

¹ Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

² Children Growth Disorder Research Center, Comprehensive Research Institute for Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

³ Radiology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

While splenic abscesses are rare, they are potentially life-threatening conditions in children, with an estimated incidence of 0.05 to 0.7%. Streptococcus anginosus, a member of the S. anginosus group, is an infrequent yet important etiology in this context due to its pronounced propensity for abscess formation. We reported the successful spleen-preserving management of a large, multiloculated pediatric splenic abscess caused by S. anginosus using ultrasound-guided catheter drainage and targeted antibiotic therapy.
A 10-year-5-month-old Iranian boy presented with a 2-week history of persistent fever and left upper quadrant (LUQ) pain. Laboratory studies revealed leukocytosis (12,900/μL), 
thrombocytosis (699×10³/μL), microcytic anemia, and a markedly elevated erythrocyte sedimentation rate (ESR, 125 mm/h). 
Coronavirus disease 2019 (COVID-19) polymerase chain reaction (PCR) testing was positive despite the absence of respiratory symptoms. Abdominal ultrasound and contrast-enhanced computed tomography (CECT) demonstrated splenomegaly with a large, multiloculated abscess (maximum diameter: 13.5 cm; estimated volume ≈526 mL). Ultrasound-guided pigtail catheter drainage yielded purulent fluid. Gram staining revealed Gram-positive cocci, and culture grew S. anginosus susceptible to penicillin, ampicillin, ceftriaxone, and vancomycin. 
The patient became afebrile by hospital day 3, and interval ultrasound on day 5 showed marked abscess reduction, allowing for catheter removal. He was discharged after 7 days and completed a 6-week antimicrobial course (2 weeks intravenous, 4 weeks oral). At the 4-week follow-up, he was asymptomatic, with normalization of inflammatory markers (ESR: 2 mm/h, white blood cell [WBC] count: 7,900/μL) and complete radiological resolution on ultrasound, confirming effective spleen preservation without complications.
This case illustrated the effectiveness of ultrasound-guided drainage and targeted antibiotics for large pediatric splenic abscesses due to S. anginosus. It highlighted the importance of early recognition, appropriate imaging, microbiological confirmation, and a multidisciplinary approach to optimize clinical outcomes while preserving splenic function.

Highlights

Mohammadmoein Mokhtarezadeh (Google Scholar)
Mehran Karimi (Google Scholar)

Keywords

• Splenic abscess
• Streptococcus anginosus
• Child
• Drainage
• Conservative treatment