Role of Diagnostic Splenectomy in Patients Presenting with Pyrexia of Unknown Origin with Splenomegaly and Non-Contributory Pre-surgical Evaluation

摘要

Aims: To describe the clinical and laboratory profile, post-surgical complicationsand longitudinal outcomes in a historical cohort of pyrexia of unknown origin(PUO) patients with splenomegaly who underwent a diagnostic splenectomyfollowing non-contributory extensive pre-surgical laboratory and radiologicalevaluation.Materials and Methods: This retrospective study was conducted in a 2700 bedteaching hospital in South India, in eligible patients, over a 10-year period.Results: Out of 38 PUO patients who underwent diagnostic splenectomy, a finaldiagnosis was established in 30 patients. Overall, infections contributed to 44 %(13/30), and neoplasia to 56% (17/30) of all cases. Of PUO patients with infections3/13 (23%) were diagnosed with disseminated tuberculosis, 7/13 (54%) withmelioidosis, 1/13 (8%) with Candidal splenic abscess with infective endocarditisand 2/13 (15%) with Colistin-resistant E. coli splenic abscess. Amongst PUOpatients with neoplasia (17/30), all patients were diagnosed with hematologicalneoplasia. Of these 94% (16/17) were diagnosed with Non-Hodgkin’s lymphomaand 6% (1/17) with Hodgkin’s disease. Splenectomy was non-contributory in 21%(8/38) patients. Post-operative complications were seen in 6/38 patients whorequired monitoring in the intensive care unit (ICU).In-hospital mortality wasnoted in 10.5% (4/38) patients.Conclusions: Diagnostic splenectomy has high diagnostic utility in the evaluationof PUO patients with reticuloendothelial system involvement after an extensivenegative investigative workup. The diagnosis of lymphoma in such patients ismore common than an infective cause.