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Splenic abscess complicating gastroenteritis due to Salmonella Virchow in an immunocompetent host

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Clinical record

A 20-year-old man was admitted to a regional hospital with fevers, rigors, anorexia and left upper quadrant pain. It was his fourth presentation to the emergency department in the preceding 10 days. On the first two presentations, he had been sent home with a provisional diagnosis of renal colic. After review by his general practitioner, he had undergone outpatient imaging that identified filling defects in the pulmonary arteries of his left lower lobe, which were reported as being consistent with pulmonary emboli. In addition, two hypodense splenic lesions were identified, as well as collapse and possible consolidation of the left lower lobe. His GP had referred him to the emergency department for further review (his third presentation), after which he had commenced therapeutic anticoagulation for a presumed diagnosis of pulmonary emboli.

The patient’s history was notable for a self-limiting episode of gastroenteritis 6 weeks before his initial presentation, with sick family contacts. On his fourth presentation, he described progressive left upper quadrant and flank pain over the preceding 10 days, with intermittent fevers and rigors. He had no other focal infective symptoms on review.

On examination, he was found to have a fever (temperature, 39.3°C), sinus tachycardia (heart rate, 154 beats/min), tachypnoea (respiratory rate, 28 breaths/min), hypotension (blood…