Abstract / Summary
Splenic abscess is a rare but potentially life-threatening condition, most frequently seen in immunocompromised individuals or those with significant underlying comorbidities. Monomicrobial bacterial infections predominate, whereas fungal or mixed infections are uncommon, particularly in immunocompetent hosts. Concurrent bacterial and fungal infection of the spleen is exceedingly rare. We report the case of a 30-year-old immunocompetent Indian male who presented with high-grade fever, left upper quadrant abdominal pain, and gastrointestinal symptoms. Imaging demonstrated a multiseptated cystic lesion in the upper pole of the spleen consistent with abscess formation. Endoscopic ultrasound-guided fine-needle aspiration yielded purulent material, and culture revealed dual infection with Salmonella enterica serovar Paratyphi A and Candida tropicalis. Blood cultures and tuberculosis workup were negative. Despite broad-spectrum empirical antimicrobial therapy, radiological progression necessitated laparoscopic drainage and debridement, followed by culture-directed antibacterial therapy for a total of 5 weeks and antifungal therapy for 6 weeks. The patient achieved complete clinical and radiological resolution with preservation of splenic function. This case highlights the importance of maintaining a high index of clinical suspicion for splenic abscess and considering polymicrobial infection, including fungal pathogens, even in immunocompetent patients. Prompt microbiological diagnosis, early multidisciplinary involvement, timely spleen-sparing source control, and targeted antimicrobial therapy guided by susceptibility testing facilitated successful organ preservation while avoiding splenectomy, ultimately resulting in a favorable clinical outcome.