Splenic abscess secondary to COVID-19 infection – A case report

INTRODUCTION AND IMPORTANCE: The sequelae of COVID-19 infection are largely unknown. There are reports of abscess formation in patients with recent COVID-19 infection, likely due to the formation of microthrombi secondary to endothelial damage. This case report describes an unvaccinated patient who presented with a large splenic abscess after recent symptomatic COVID-19 infection. CASE PRESENTATION: A man in his forties with recent symptomatic COVID-19 infection presented to the emergency room with worsening left-sided abdominal and flank pain associated with subjective fever and chills. On physical exam he was significantly tender to palpation in the left hemi-abdomen with a palpable left upper quadrant mass. CT scan demonstrated a large intra-splenic fluid collection. He underwent drainage by interventional radiology with return of 400 cm(3) of purulent material, which grew Staphylococcus aureus. Blood cultures were negative and transesophageal echocardiogram revealed no endocarditis. Further workup by infectious disease revealed no identifiable source of the splenic abscess. The patient was treated with intravenous antibiotics and clinically improved without surgical intervention. CLINICAL DISCUSSION: Several studies have shown that SARS-CoV-2, the virus that causes COVID-19, injures the endothelium resulting in endothelial dysfunction. This dysfunction creates a prothrombotic state leading to the formation of thrombi in both large and small vessels. It has been suggested that microthrombi may contribute to the formation of abscesses. CONCLUSION: In the absence of other etiologies despite a thorough workup, it is believed that this patient's recent COVID-19 infection led to the formation of microthrombi within his splenic vasculature allowing for abscess formation.