RESUMO
We report the first paediatric case of splenic infarction following acute Mycoplasma pneumoniae infection with induction of anti-prothrombin (aPT) antibodies. A 12-year-old boy was admitted to the paediatric emergency department for a left pleuropneumonia and a splenic infarction. aPT antibodies were transitorily detected. The patient recovered fully after antibiotic therapy and a 3-month course of anticoagulation treatment. Antiphospholipid (aPL) antibodies induced by acute infections have already been reported but cases of clinically relevant thrombosis remain rare. The pathogenicity of aPT antibodies is discussed here. We hypothesize that these antibodies were involved in this symptomatic hypercoagulable state.
Assuntos
Pneumonia por Mycoplasma/complicações , Infarto do Baço/microbiologia , Doença Aguda , Autoanticorpos/sangue , Criança , Humanos , Masculino , Pneumonia por Mycoplasma/sangue , Protrombina/imunologia , Infarto do Baço/sangueAssuntos
Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Infarto do Baço/microbiologia , Antibacterianos/uso terapêutico , Criança , Doxiciclina/uso terapêutico , Humanos , Masculino , Tifo por Ácaros/tratamento farmacológico , Infarto do Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (Pâ=â.01), had liver disease (Pâ=â.001) with natural valve (Pâ=â.050) and mitro-aortic valve involvement (Pâ=â.042), splenomegaly (Pâ=â.001), nonabdominal emboli (Pâ=â.001), and a greater number and larger vegetation (>15âmm, Pâ=â.049) in the mitro-aortic valves (Pâ=â.051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR]â=â3.6, 95% confidence interval [CI] = 1.4-9.1), liver disease (ORâ=â8.3, 95% CIâ=â2.1-31.8), and nonabdominal emboli (ORâ=â5.2, 95% CIâ=â2.3-11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.
Assuntos
Endocardite/complicações , Infarto/diagnóstico por imagem , Rim/irrigação sanguínea , Fígado/irrigação sanguínea , Infarto do Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Endocardite/diagnóstico por imagem , Feminino , Humanos , Infarto/microbiologia , Rim/diagnóstico por imagem , Rim/microbiologia , Fígado/diagnóstico por imagem , Fígado/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Baço/irrigação sanguínea , Baço/diagnóstico por imagem , Baço/microbiologia , Infarto do Baço/microbiologiaRESUMO
Culture negative endocarditis (CNE) is a common concern in patients with fever, heart murmur, cardiac vegetation, and negative blood cultures. The diagnosis of CNE is not based only on negative blood cultures and a cardiac vegetation. The clinical definition of CNE is based on negative blood cultures plus the findings of culture positive infective endocarditis (IE), e.g., fever, cardiac vegetation, splenomegaly, peripheral manifestations. Because embolic splenic infarcts may occur with culture positive IE, some may assume that splenic infarcts are a sign of CNE. Previously, CNE was due to fastidious and non-culturable organisms. With current diagnostic methods, fastidious organisms grow in 2-3 days. Therefore, fastidious IE are a subset of culture positive IE, but do not represent true CNE. We describe a case of an elderly female who presented with a fever of unknown origin (FUO) and multiple splenic infarcts thought by some to represent CNE. An extensive workup for CNE pathogens was negative. The final cause of her splenic infarcts was a diffuse large B-cell lymphoma (DLBCL). Review of the literature, as well as this case, confirms that splenic infarcts are not a feature of CNE. In patients with fever, splenic infarcts, and negative blood cultures, physicians should search for an alternate explanation rather than CNE, e.g., malignancy and hypercoaguable state (lupus anticoagulant).
Assuntos
Endocardite/diagnóstico , Febre de Causa Desconhecida/microbiologia , Neoplasias/diagnóstico , Infarto do Baço/microbiologia , Abdome/diagnóstico por imagem , Idoso , Contagem de Colônia Microbiana , Diagnóstico Diferencial , Endocardite Bacteriana/diagnóstico , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Neoplasias/complicações , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis. CASE PRESENTATION: We present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis. The patient underwent urgent right hepatic artery ligation and splenectomy. The postoperative course was complicated by an episode of hemobilia due to the rupture of a partially thrombosed mycotic aneurysm into the biliary tree. Thus, selective radiological embolization of the left hepatic artery branches was necessary. CONCLUSION: To our knowledge, this is the first case reported of infected aneurysms of visceral arteries caused by Group B streptococcus infection. Clinical and laboratory findings were non-specific, while imaging features with computed tomography scan and angiography were highly suggestive. In our case, early recognition, culture-specific intravenous antibiotics and urgent surgical treatment combined with interventional radiology played a decisive role in the final result.
Assuntos
Aneurisma Infectado/complicações , Endocardite Bacteriana/complicações , Hepatopatias/complicações , Infarto do Baço/complicações , Streptococcus agalactiae , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Hepatopatias/microbiologia , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Esplenectomia , Infarto do Baço/microbiologia , Infarto do Baço/cirurgiaAssuntos
Aneurisma Infectado/microbiologia , Artéria Braquial/diagnóstico por imagem , Endocardite Bacteriana/complicações , Infarto do Baço/microbiologia , Adulto , Aneurisma Infectado/diagnóstico por imagem , Humanos , Masculino , Infarto do Baço/diagnóstico por imagem , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estreptococos ViridansRESUMO
Brucellosis is globally the most prevalent multisystem infection of zoonotic origin, while it is still one of the most important public health problems in Turkey as non-pasteurised milk and dairy products are consumed. Early diagnosis is vital to prevent the possibly lethal complications caused by the disease. However, diagnosis might be delayed as the disease does not have a single and typical manifestation and presents with various symptoms of different systems. Brucellosis and associated splenic infarct have rarely been studied, there being few cases in the literature. One of the rare involvements in this disease is dermatological involvement, which has been found in less than 10 percent of brucellosis cases. In this study, we discuss a 17 year old male patient who was admitted to our hospital due to fever, abdominal pain, arthralgia and rash on legs, diagnosed with brucellosis through brucellosis tube agglutination test and found to have splenic infarct upon examination and leukocytoclastic vasculitis according to the skin biopsies in the light of the present literature.
Assuntos
Brucella , Brucelose/complicações , Infarto do Baço/diagnóstico , Infarto do Baço/microbiologia , Vasculite Leucocitoclástica Cutânea/diagnóstico , Vasculite Leucocitoclástica Cutânea/microbiologia , Dor Abdominal/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Artralgia/microbiologia , Brucella/imunologia , Exantema/microbiologia , Febre/microbiologia , Humanos , Perna (Membro)/patologia , Masculino , Fatores de Risco , Infarto do Baço/tratamento farmacológico , Resultado do TratamentoRESUMO
We report a case of disseminated infection with Mycobacterium genavense in a 58 year old HIV positive woman presenting with fever, diarrhea, abdominal pain and weight loss. She had a striking hepatosplenomegaly, abdominal lymphadenopathy, anaemia and thrombopenia. Direct smears and cultures of blood, stool, sputum, urine and bone marrow were negative for common and opportunistic microorganisms. Splenectomy revealed numerous acid fast bacill. Lumbar puncture also showed acid fast bacilli at direct examination. Specific PCR and 16s rRNA gene sequencing identified M. genavense. The outcome was fatal despite antimycobacterial therapy. M. genavense must be included in the differential diagnosis of fever, weight loss, lymphadenopathy and splenomegaly in immunocompromised patients. Prompt diagnosis is based on molecular biology methods. Empirical therapy, using at least three antimycobacterial agents, including clarithromycin should be introduced in case of high clinical suspicion.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Meningite/microbiologia , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infarto do Baço/microbiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Animal bites are typically harmless, but in rare cases infections introduced by such bites can be fatal. Capnocytophaga canimorsus, found in the normal oral flora of dogs, has the potential to cause conditions ranging from minor cellulitis to fatal sepsis. The tendency of C. canimorsus infections to present with varied symptoms, the organism's fastidious nature, and difficulty of culturing make this a challenging diagnosis. Rarely, bacterial cytotoxins such as those produced by C. canimorsus may act as causative agents of TTP, further complicating the diagnosis. Early recognition is crucial for survival, and the variability of presentation must be appreciated. We present the first known case of C. canimorsus infection resulting in TTP that initially presented as splenic infarction. CASE PRESENTATION: 72-year-old Caucasian male presented with a four-day history of abdominal pain, nausea, vomiting, diarrhea, and intermittent confusion. On presentation, vital signs were stable and the patient was afebrile. Physical examination was unremarkable apart from petechiae on the inner left thigh, and extreme diffuse abdominal pain to palpation and percussion along with positive rebound tenderness. Initial investigations revealed leukocytosis with left shift and thrombocytopenia, but normal liver enzymes, cardiac enzymes, lipase, INR and PTT. Abdominal CT demonstrated a non-enhancing spleen and hemoperitoneum, suggesting complete splenic infarction. Although the patient remained afebrile, he continued deteriorating over the next two days with worsening thrombocytopenia. After becoming febrile, he developed microangiopathic hemolytic anemia and hemodynamic instability, and soon after was intubated due to hypoxic respiratory failure and decreased consciousness. Plasma exchange was initiated but subsequently stopped when positive blood cultures grew a gram-negative organism. The patient progressively improved following therapy with piperacillin-tazobactam, which was switched to imipenem, then meropenem when Capnocytophaga was identified. CONCLUSIONS: There is a common misconception amongst practitioners that the presence of systemic infection excludes the possibility of TTP and vice versa. This case emphasizes that TTP may occur secondary to a systemic infection, thereby allowing the two processes to coexist. It is important to maintain a wide differential when considering the diagnosis of either TTP or C. canimorsus infection since delays in treatment may have fatal consequences.
Assuntos
Mordeduras e Picadas/complicações , Capnocytophaga/isolamento & purificação , Cães , Infecções por Bactérias Gram-Negativas/complicações , Púrpura Trombocitopênica Trombótica/etiologia , Infarto do Baço/etiologia , Idoso , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Imipenem/uso terapêutico , Masculino , Meropeném , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Púrpura Trombocitopênica Trombótica/microbiologia , Infarto do Baço/tratamento farmacológico , Infarto do Baço/microbiologia , Tienamicinas/uso terapêuticoRESUMO
OBJECTIVE: To determine clinical, echocardiographic features, management and outcomes of patients presenting peri aortic abscess complicating infective endocarditis (IE) and demonstrate the impact of periaortic abscess on morbidity and mortality of these patients. METHODS: We have analyzed clinical, microbiological, echocardiographic aspects, therapies and outcomes of patients with aortic abscess occurring during IE, and we compared these data with those of patients presenting IE without peri aortic abscess in the same period in the cardiology department of the University Hospital of Marrakech from January 2006 to January 2010. RESULTS: Above 56 cases of infective endocarditis, 16 patients had an aortic abscess. Mean age was 33 ± 11 years with a clear male predominance in the group IE with abscess versus IE without abscess. Heart failure was noted in all patients in periaortic abscess group, and was more severe in this group compared to control. Streptococcus and staphylococcus predominated with no significant difference between the two groups. Transthoracic echocardiography coupled with transesophageal echocardiography made the diagnosis of aortic abscess witch was isolated in 11 cases and associated with other complications in five cases. In terms of complications, splenic infarction was more frequent in the group with abscess (25 versus 2.5%, P<0.05). There was not a significant difference between the two groups for the others complications. Surgery associated with a double antibiotic therapy was the standard treatment with a variable delay for surgery of four days to four weeks. Hospital mortality in the acute phase was higher in periaortic abscess group (37% versus 10%, P<0.05). The evolution of survivors at six months was favorable. CONCLUSION: Periaortic abscess complicating IE is associated with a high morbidity and mortality in spite of modern approach as well as on medical or surgical treatment. It requires therefore a strict monitoring of patients with infective endocarditis.
Assuntos
Abscesso/microbiologia , Abscesso/mortalidade , Doenças da Aorta/microbiologia , Endocardite Bacteriana/complicações , Abscesso/diagnóstico por imagem , Abscesso/terapia , Adulto , Algoritmos , Antibacterianos/uso terapêutico , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/terapia , Criança , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/terapia , Feminino , Seguimentos , Insuficiência Cardíaca/microbiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Infarto do Baço/microbiologia , Staphylococcus/isolamento & purificação , Streptococcus/isolamento & purificação , Taxa de Sobrevida , Resultado do Tratamento , UltrassonografiaRESUMO
We report a case of a patient with splenic infarction possibly attributable to Mycoplasma pneumoniae infection without accompanying pneumonia. A 24-year-old man was admitted to our hospital with a 7-day history of fever, sore throat, and left upper-quadrant abdominal pain. Chest radiography revealed no active lung lesions; however, abdominal computed tomography showed hepatosplenomegaly with splenic infarction. At the time of admission, the patient's serum IgM titer for M. pneumoniae was 79.7 U/mL (positive titer >70 U/mL). Two weeks later, the serum IgM titer for M. pneumoniae had markedly increased to 3,158.1 U/mL. The patient was treated with azithromycin, and his symptoms began to improve. After 5 weeks, the spleen size decreased, and a scar was observed at the site of the infarct.
Assuntos
Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/microbiologia , Infarto do Baço/microbiologia , Anticorpos Antibacterianos/sangue , Humanos , Masculino , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/patologia , Radiografia , Baço/diagnóstico por imagem , Baço/patologia , Infarto do Baço/sangue , Infarto do Baço/patologia , Adulto JovemRESUMO
Peptostreptococcus sp., which are normal flora of human mucocutaneous surfaces, can be recovered in mixed infections involving the skin, soft tissue, respiratory tract, gastrointestinal tract and genitourinary tract. Peptostreptococci are rarely reported to be the cause of infective endocarditis. Because of their fastidiousness, peptostreptococci are difficult to isolate and are often overlooked. The authors report a case of Peptostreptococcus infective endocarditis of a native mitral valve complicated by splenic infarction. The authors also review the literature to identify features of infective endocarditis caused by Peptostreptococcus anaerobius.
Assuntos
Endocardite Bacteriana/complicações , Infecções por Bactérias Gram-Positivas/complicações , Peptostreptococcus , Infarto do Baço/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Fatores de Risco , Infarto do Baço/diagnóstico , Infarto do Baço/microbiologia , Adulto JovemRESUMO
Patients awaiting cardiac transplantation often require ventricular assist devices (VADs) due to instable circulatory condition. Device-related infections remain the 'Achilles heel' of mechanical circulatory support and wound complications after VAD placement are a formidable challenge to surgeons. Up to 25% of deaths in VAD patients are due to systemic sepsis, which occurs in 11-26% of patients and bacteria that are common pathogens including Staphylococcus, Pseudomonas, Enterococcus, and Candida. Sepsis, infection of implanted pump components, and infections of percutaneous drivelines continue to limit survival. The Berlin Heart-EXCOR VAD is a para-corporeal pulsatile system that has been successful in patients with severe biventricular dysfunction. We report a case of a 35-year-old male suffering from a postischemic cardiomyopathy who received an EXCOR biventricular assist device as a bridge to transplant. During the assistance the patient developed concomitant methicillin-resistant Staphylococcus aureus infection of implanted pump components which was resistant to conventional therapy. The patient developed sepsis with splenic infarctions due to septic embolization which was successfully treated with a heart transplant. In some extreme cases of VAD infections, such as this, the only therapeutic option is transplantation or device replacement.
Assuntos
Cardiomiopatias/terapia , Embolia/microbiologia , Coração Auxiliar/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Sepse/microbiologia , Infarto do Baço/microbiologia , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Embolia/terapia , Transplante de Coração , Humanos , Masculino , Desenho de Prótese , Infecções Relacionadas à Prótese/terapia , Sepse/terapia , Esplenectomia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/diagnóstico , Endocardite Bacteriana/complicações , Infarto da Artéria Cerebral Média/etiologia , Animais , Antibacterianos/uso terapêutico , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/tratamento farmacológico , Gatos/microbiologia , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Imunocompetência , Infarto/diagnóstico por imagem , Infarto/etiologia , Infarto/microbiologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/microbiologia , Artéria Renal/microbiologia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Infarto do Baço/microbiologia , Tomografia Computadorizada por Raios X , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Adulto JovemRESUMO
We report a case of spontaneous splenic rupture (SSR) caused by a Bacillus species (sp.) infection. A 36-year-old man on warfarin therapy since an aortic valve replacement at the age of 13 was admitted to our hospital with a 3-week history of a high fever. He had been asymptomatic until 4 months previously, when he suffered a cerebral embolism despite adequate oral anticoagulation. Abdominal computed tomography revealed splenic infarctions, which resulted in splenic rupture 2 days later. After embolization of the splenic artery, splenectomy was successfully performed. Pathologic examination revealed splenic infarction, resulting from septic emboli, with associated rupture of the splenic capsule, but no abscess was found. Bacillus sp. was isolated from cultures of arterial blood preoperatively, and the excised splenic specimens, postoperatively. In addition to rupture of the suppurating intrasplenic vessels with hematoma formation, the anticoagulant therapy possibly contributed to distension of the intrasplenic hematoma.
Assuntos
Bacillus/isolamento & purificação , Infecções Bacterianas/complicações , Infarto do Baço/microbiologia , Ruptura Esplênica/etiologia , Adulto , Anticoagulantes/efeitos adversos , Infecções Bacterianas/cirurgia , Próteses Valvulares Cardíacas , Hematoma/etiologia , Humanos , Masculino , Ruptura Espontânea , Esplenectomia , Infarto do Baço/complicações , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Splenic infarction is a very rare event though it can occur in a multitude of conditions with general or local manifestations. Splenic involvement in infectious endocarditis can be either infarction or abscess formation. The clinical picture is usually nonspecific and the diagnosis is often not initially suspected. We present a case of a 67 year-old male patient with infectious endocarditis who has been diagnosed with a splenic infarction by abdominal CT scan. The infarction was a result of septic embolization from the infected endocardium. The patient was initially managed conservatively with triple antibiotic therapy and regular follow-up ultrasound scan. The persistence of abdominal symptoms and the suspicion of splenic abscess formation led to the decision of performing splenectomy. Although imaging can characterize the nature of a splenic lesion, it is sometimes impossible to differentiate between infarction and abscess without histopathological confirmation. Splenic infarction should be suspected in all patients with a past history of thromboembolic disease who complain of left upper quadrant pain and present with localized or systemic inflammatory signs. Unfavorable clinical course and suspicion of abscess formation are indications for surgery. The characteristic features of splenic infarction are discussed together with a review of the recent literature.
Assuntos
Endocardite Bacteriana/cirurgia , Infarto do Baço/cirurgia , Infecções Estafilocócicas/cirurgia , Staphylococcus epidermidis , Idoso , Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Esplenectomia , Infarto do Baço/diagnóstico , Infarto do Baço/tratamento farmacológico , Infarto do Baço/microbiologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis/isolamento & purificação , Resultado do TratamentoRESUMO
Systemic embolization is the most common extracardiac complication of active infective endocarditis (IE). The assessment of individual patient risk for embolic events in active IE is very difficult. Staphylococcal or fungal endocarditis, infections caused by HACEK and Abiotrophia spp. microorganisms, anterior mitral leaflet vegetations and vegetations with size >10 mm in TTE are associated with higher rate of arterial embolization. In this report we present a 66-year-old patient with active enterococcal aortic native valve endocarditis, with a history of gastric ulcers and with acute abdominal pain due to splenic infarction. We conclude that abdominal pain, particularly in the left-upper-quadrant, may be a sign of splenic infarction. Confirmation of this complication by ultrasonography provides important information about increased risk of future systemic embolic events.