SPLENIC ABSCESS AND THE GENE FOR HEMOGLOBIN S

Twenty-two cases of splenic abscess in Nigerians are reviewed; 2 were of the secondary type and 20 were primary splenic abscesses. Roentgenographically, 3 types of abscesses were distinguished: Type A with findings related only to splenomegaly; Type B with splenomegaly and gas within the abscess (pyogaseous abscess); and Type C with findings of localized or generalized peritonitis in addition to splenomegaly.

Fifteen patients with primary abscesses had hemoglobin electrophoresis done; 13 had Hb S present. Almost all patients with Type A abscesses had hemoglobin AS (sickle cell trait) electrophoretically. All patients with primary pyogaseous abscesses (Type B) had hemoglobin SC disease. There were no hemoglobin SS (homozygous sickle cell anemia) patients among those who had hemoglobin electrophoresis done. These findings and associations are discussed. The gene for Hb S is thought to be a significant factor in the etiology of primary splenic abscesses. It is important to recognize that Hb AS persons, who are usually asymptomatic, can develop this serious condition (primary splenic abscess) apparently without any unusual precipitating circumstances.

The clinical features in our cases were similar to previous reports. About 50 per cent of our cases had sterile cultures. Salmonella organisms were grown from 2 abscesses in patients with Hb SC disease.

The roentgenologic and therapeutic aspects of splenic abscesses are briefly discussed.

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