Rare case of pyoderma gangrenosum originating in the spleen

Description

A 51-year-old woman with a moderately controlled type 2 diabetes and previous diagnosis of pyoderma gangrenosum (PG) of the neck presented with acute fever, left upper quadrant pain and isolated splenomegaly. Abdominal contrast-enhanced CT demonstrated loculated splenic collections with thick enhancing walls (figure 1) suspicious for abscess. Although we considered an infectious abscess in the spleen as a differential diagnosis, blood cultures had no growth. After 1 week of antibiotics, imaging demonstrated enlargement of the splenic lesions. Open splenectomy was performed because antibiotics did not show an effect and there was a concern for splenic rupture. The splenic abscesses (figure 2) contained large numbers of inflammatory cells, mainly neutrophils.

Figure 1

Abdominal contrast-enhanced CT demonstrated loculated splenic collections with thick enhancing walls (figure 1) suspicious for abscess.

Figure 2

Pathology findings in the spleen showing splenic...

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