Published online Feb 28, 2021. doi: 10.3748/wjg.v27.i8.751
Peer-review started: November 23, 2020
First decision: December 21, 2020
Revised: January 18, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: February 28, 2021
Processing time: 94 Days and 2.9 Hours
Endoscopic ultrasound-guided fine needle aspiration or biopsy (EUS-FNA or FNB) has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety. To the best of our knowledge, no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described. Herein, we report a rare case of septic shock after EUS-FNB of a splenic mass.
A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass. A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging. EUS of the spleen showed a 6 cm-sized, relatively well-demarcated, heterogeneous mass, and EUS-FNB with a 22G needle was performed. Ten days after the procedure patient developed septic shock and a splenic abscess was identified. Blood culture revealed growth of Granulicatella adiacens. After the treatment with antibiotics the patient underwent surgical resection, and the pathological examination showed diffuse large B-cell lymphoma. The patient received chemotherapy and he is in complete remission.
Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.
Core Tip: As the risk of infection after endoscopic ultrasound (EUS)-guided sampling of a solid organ is very low, prophylactic antibiotics are generally not recommended. However, our patient developed an abscess after EUS-guided fine needle biopsy of a splenic tumor. To the best of our knowledge, this is the first case of septic shock after EUS-guided fine needle biopsy of a splenic large B cell lymphoma and of an infection caused by Granulicatella adiacens during this procedure. Therefore, we suggest considering prophylactic antibiotic usage for EUS-guided sampling of splenic tumors.