Aseptic Abscesses as Precursory Extraintestinal Manifestations of Inflammatory Bowel Disease (IBD): 950

Purpose: Isolated splenic abscesses can offer a diagnostic dilemma. Most often, an infectious etiology is found. However, in cases where the abscess is sterile, diagnosis and treatment are less clear. Here we present a case of aseptic splenic abscess and a review of the literature on this subject. Methods: An OVID, Google and PubMed search was performed using the terms ‘splenic abscess,' ‘sterile abscess' and ‘aseptic abscess' for the years 1996 to present. Case Report: 19 yo Caucasian female with 6 month history of recurrent pustular lesions and 2 month history of isolated splenic abscesses, refractory to multiple courses of broad spectrum antibiotics was admitted to the hospital for further assessment. The patient had been well until she developed cellulitis after an ankle fracture requiring a cast 6 months prior. She then developed recurrent episodes of pustular lesions of the lower extremities with negative cultures. Later she developed fever and underwent assessment for abdominal pain. CT identified abscesses in her spleen. The size of her splenic abscesses continued to increase despite treatment with multiple antibiotics. Culture and aspirate of the abscesses were negative. Skin biopsy results revealed acute and chronic inflammation but no evidence of Sweet's syndrome. Full immunologic, rheumatologic and infectious work-up was found to be negative. An IBD panel was sent and revealed S. cerevisiae IgA 49.9U (>25 considered +) and S. cerevisiae IgG 29.3U (20.1-29.9 equivocal). She underwent an EGD which was unrevealing, later underwent a colonoscopy which revealed acute ileitis, colitis and proctitis consistent with IBD. Corticosteroids were started then transitioned to azathioprine with continued resolution of both skin and splenic findings and no further evolution of her IBD symptoms. Discussion: In a series of 30 patients with aseptic abscesses, 21 patients had inflammatory bowel disease (IBD), which is often asymptomatic as in the case of our patient. This group of patients tended to present with elevated WBC, ESR and negative infectious work-up. Conclusion: Aseptic splenic abscess can be an early manifestation of IBD. In patients with abscess, leukocytosis, elevated ESR and poor response to IV antibiotics, IBD should be considered in the differential diagnosis.Figure: No Caption available.