Eigendorff, Farina

Hauptmann, Lisa

Hochhaus, Andreas

Kißler, Hermann

Malouhi, Amer

Midic, Danica

Prims, Florian

Rödel, Jürgen

Schnetzke, Ulf

Scholl, Sebastian

Theis, Bernhard

English

Digitale Bibliothek Thüringen

Vol.:(0123456789) Annals of Hematology (2023) 102:1609–1611 https://doi.org/10.1007/s00277-023-05208-3LETTER TO THE EDITORStaphylococcus intermedius infection with splenic abscesses in a patient with acute lymphoblastic leukemiaLisa Hauptmann1,2 · Danica Midic1 · Farina Eigendorff1 · Amer Malouhi3 · Bernhard Theis4 · Hermann Kißler5 · Jürgen Rödel6 · Florian Prims7 · Andreas Hochhaus1 · Sebastian Scholl1 · Ulf Schnetzke1 Received: 27 March 2023 / Accepted: 29 March 2023 / Published online: 4 April 2023 © The Author(s) 2023Dear Editor,We report a case of disseminated Staphylococcus inter-medius infection causing multiple spleen abscesses with consecutive splenectomy in a patient with acute lympho-blastic leukemia.A 49-year-old female patient underwent induction chemotherapy in accordance with the Germany Multicentre Study Group (GMALL) 08/2013 protocol for a precursor B-cell acute lymphoblastic leukemia (ALL). Fever episodes occurred during neutropenia, accompanied by intermit-tent left flank pain and increased inflammation parameters with a maximum C-reactive protein of 368.9 mg/l (normal range, < 5.0 mg/l). Extensive microbiological diagnostics including multiple blood and urine cultures did not reveal any relevant pathogens. Despite broad-spectrum antimicro-bial therapy including a combination therapy of meropenem, linezolid, and fosfomycin, later ceftazidime, tigecycline, and liposomal amphotericin B, no improvement of clinical and laboratory parameters was achieved. Abdominal computed tomography scan revealed multilocular splenic abscesses (Fig. 1a). A transthoracic echocardiography showed no evidence of endocarditis and a magnetic resonance imag-ing (MRI) of the brain did not reveal any cerebral septic abscess. A diagnostic spleen puncture was performed and no causative pathogen or evidence of leukemic infiltration was found. Due to the persistently uncontrollable infec-tion, splenectomy was performed. The histological work-up showed a pronounced infiltration by neutrophilic granulo-cytes (Fig. 1b). Staphylococcus intermedius was identified from splenic abscessus material as the causative pathogen by isolation on Columbia sheep blood agar and identification using MALDI-TOF (Vitek MS, bioMérieux, Nürtingen, Ger-many). Following splenectomy, febrile episodes and flank pain ceased and a distinct decline in inflammation parame-ters was recorded (Fig. 1c). With regard to ALL, a sustained complete remission without evidence of measurable residual disease (MRD) was detected by bone marrow puncture. One month after splenectomy, chemotherapy was continued with first consolidation according to the GMALL 08/2013 proto-col. During the following neutropenic episodes, the patient received prophylactic therapy with cefazolin in addition to standard antimicrobial prophylaxis. No infectious complica-tions occurred during the following cycles of chemotherapy with ongoing negativity for MRD of the ALL.Hepatosplenic abscesses in AML patients during neu-tropenia are often caused by disseminated candidiasis [1]. Staphylococcus intermedius rarely occurs in humans and is much more common in animals such as dogs [2]. A review of the literature revealed that twenty-seven of 33 cases (75.8%) had exposure to dogs [3]. The patient described here frequently works with dogs every day due to her occupation. The vast majority of infections cause skin abscesses and wound infections [4–6]. Device-asso-ciated infections, brain abscesses, or even meningitis may occur rarely [3, 7, 8]. Rarely, spleen abscesses have been reported due to Staphylococcus spp. [9]. All patients  * Ulf Schnetzke  ulf.schnetzke@med.uni-jena.de1 Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany2 Klinik für Innere Medizin III, Nephrologie, Universitätsklinikum Jena, Jena, Germany3 Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany4 Institut für Rechtsmedizin Sektion Pathologie, Universitätsklinikum Jena, Jena, Germany5 Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Germany6 Institut für Medizinische Mikrobiologie, Universitätsklinikum Jena, Jena, Germany7 Klinik für Innere Medizin, Hämatologie und Onkologie, SRH Klinikum Naumburg, Naumburg, Germany1610 Annals of Hematology (2023) 102:1609–16111 3reported were immunocompetent. Here, we present a case of splenic abscesses due to a disseminated infection with Staphylococcus intermedius. Even though the patient was treated in accordance to antimicrobial resistogram, clinical and laboratory parameters did not improve until splenec-tomy as a causative treatment option was performed.When untreated, splenic abscess has a high mortality rate reaching up to 70% but can be reduced by applying appropriate treatment to less than 1%. High-dose paren-teral broad-spectrum antibiotics play an important role in the treatment of splenic abscesses. Even though percutane-ous aspiration and drainage approaches are becoming more popular, splenectomy remains the gold standard especially in patients with multilocular abscess [10, 11].Usually, infections due to Staphylococcus intermedius are susceptible to glycopeptides (vancomycin), macrolides (erythromycin), aminoglycosides, and most often penicil-lins [3]. Despite long-term antibiotic treatment, according resistogram the patient described here did not show any clinical and laboratory improvement until splenectomy was performed.To our knowledge, this is the first report of clinical mani-festation of Staphylococcus intermedius infection causing splenic abscesses in an immunocompromised patient. In case of persistent signs and symptoms of infection despite Fig. 1  a Splenic abscesses on computed tomography scan. b Histology of splenic tissue dem-onstrating neutrophil infiltration caused by the Staphylococcus intermedius infection. c Body temperature (°C) and C-reactive protein (CRP) before and after splenectomya)b)c)1611Annals of Hematology (2023) 102:1609–1611 1 3broad-spectrum antibiotic treatment, surgical approaches such as percutaneous aspiration or splenectomy should be considered. This case also illustrates that immunocompro-mised patients require very close clinical observation due to a high rate of morbidity and mortality caused by infectious diseases.Funding Open Access funding enabled and organized by Projekt DEAL.Declarations Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. There is writ-ten consent of the patient about the scientific publication.Conflict of interest The authors declare no competing interests.Open Access This article is licensed under a Creative Commons Attri-bution 4.0 International License, which permits use, sharing, adapta-tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.References 1. Grois N, Mostbeck G, Scherrer R, Chott A, Schwarzinger I, Muhm M, Bettelheim P, Forstinger C, Laczika K, Kyrle PA et al (1991) Hepatic and splenic abscesses–a common complication of inten-sive chemotherapy of acute myeloid leukemia (AML) A prospec-tive study. Ann Hematol 63(1):33–38. https:// doi. org/ 10. 1007/ bf017 14958 2. Talan DA, Goldstein EJ, Staatz D, Overturf GD (1989) Staphy-lococcus intermedius: clinical presentation of a new human dog bite pathogen. 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Int J Infect Dis 13(4):524–530. https:// doi. org/ 10. 1016/j. ijid. 2008. 08. 024 11 Bates AT, Svestka MG (2019) Management of splenic abscess. In: Docimo S Jr, Pauli EM (eds) Clinical algorithms in general sur-gery : a practical guide. Springer International Publishing, Cham, pp 409–411. https:// doi. org/ 10. 1007/ 978-3- 319- 98497-1_ 101Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Staphylococcus intermedius infection with splenic abscesses in a patient with acute lymphoblastic leukemia

Lisa Hauptmann

Danica Midic

Farina Eigendorff

Amer Malouhi

Bernhard Theis

Hermann Kißler

Jürgen Rödel

Florian Prims

Andreas Hochhaus

Sebastian Scholl

Ulf Schnetzke

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Staphylococcus intermedius infection with splenic abscesses in a patient with acute lymphoblastic leukemia

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