Int J Infect. 2019 January; 6(1):e87136. Published online 2019 January 22. doi: 10.5812/iji.87136. Case Report Typhoid Splenic Abscess: A Case Report and Literature Review Fahmi Yousef Khan 1, * 1 Department of Medicine, Hamad General Hospital, Doha, Qatar * Corresponding author: MD Consultant, Department of Medicine Hamad General Hospital, P.O. Box: 3050, Doha, Qatar. Tel: +974-55275989, Fax: +974-44321276, Email: fakhanqal@gmail.com Received 2018 December 06; Revised 2018 December 26; Accepted 2018 December 29. Abstract Introduction: Typhoid splenic abscess is a rare clinical entity that can be fatal if left untreated. Herein, we reported a case of typhoid splenic abscess who responded to ultrasound-guided aspiration and antibiotic therapy. Case Presentation: A 25-year-old Nepalese man with no significant medical history presented to the emergency department with fever and the left upper abdominal pain lasting for seven days. One month before his presentation to our hospital, he returned from an eight-week holiday in Nepal. Splenic abscess was diagnosed by abdomen ultrasound and enhanced-computerized tomography. The patient refused surgical intervention and ultrasound-guided abscess aspiration was performed while piperacillin-tazobactam was initiated. Blood and aspirated pus microscopy revealed Gram-negative bacilli and the culture grew Salmonella typhi, which was sensitive to piperacillin-tazobactam, ampicillin, ciprofloxacin, and ceftriaxone. Piperacillin-tazobactam was continued for 4 weeks with successful recovery. Conclusions: This case highlights the importance of considering typhoid splenic abscess in the differential of fever and abdominal pain in returning travelers. Keywords: Typhoid, Splenic Abscess, Splenectomy, Aspiration 1. Introduction Splenic abscess is an unusual and potentially life- threatening disease with a reported incidence of 0.14% - 0.7% in one autopsy series and bacterial abscess is the most common (1). Splenic abscess due to Salmonella typhi (S. ty- phi) is unusual, most of them associated with liver abscess whereas isolated splenic abscess is very rare. In this report, we presented a case of isolated splenic abscess due to S. ty- phi who was treated by abscess aspiration and antibiotic therapy. This case highlights the importance of considering ty- phoid splenic abscess in the differential diagnosis of fever and abdominal pain in returning travelers. 2. Case Presentation A 25-year-old healthy Nepalese patient presented to the emergency department with fever and the upper left ab- dominal pain lasting for seven days. One month prior to his presentation to our hospital, he returned from an eight-week holiday in Nepal. On examination, the patient looked sick, feverish, with a temperature of 39°C, a heart rate of 96 beats per minute and a respiratory rate of 18 breaths per minute. His blood pressure was 110/60 mmHg and the oxygen saturation was 96% in ambient air. Exami- nation of the abdomen showed a palpable, tender spleen, while the remainder of his examination was unremark- able. Laboratory tests revealed leucopenia (3.4 × 10 9 /L) and thrombocytopenia (109 × 10 9 /L). Blood chemistry, liver profile, and coagulation tests were within normal limits. Malaria parasite smear, urine analysis, and Brucella sero- logic investigation were negative. Hepatitis A IgM anti- body, hepatitis C antibody, hepatitis B markers, and anti- bodies to human immunodeficiency virus (HIV) were like- wise negative. Blood samples were sent to the laboratory for Gram staining, culture, and susceptibility tests. Imag- ing study, including chest and abdominal X-ray were un- remarkable, whereas abdominal ultrasonography showed enlarged spleen with multiple well-defined cystic focal le- sions. Contrast-enhanced computerized axial tomography (CAT) of the abdomen revealed multiple abscesses in the spleen. The largest abscess measured approximately 1.8 × 0.8 cm (Figure 1). The surgeon was consulted and recom- mended a splenectomy, but the patient refused this op- eration. Therefore, ultrasound-guided aspiration of the largest abscess was performed and a broad spectrum intra- Copyright © 2019, International Journal of Infection. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.