Spontaneous rupture of pyogenic splenic abscess in infective endocarditis

Infective endocarditis (IE) has various cardiac and extracardiac complications, which include metastatic abscesses of the solid organs such as the liver, kidney, brain, and spleen. Splenic abscess in IE is an uncommon entity, and spontaneous rupture of a large abscess in a newly diagnosed patient with IE is infrequently described in the literature. A 42-year-old male presented to us with a fever and worsening pain in his left upper quadrant. A detailed evaluation led to the diagnosis of IE and a large pyogenic splenic abscess. The blood culture had a growth of Escherichia coli. He was managed initially with intravenous antibiotics, but an urgent laparotomy and splenectomy were undertaken as he deteriorated and developed shock. Unfortunately, despite a prompt surgical intervention, he succumbed to the illness due to persistent postoperative shock. The case describes the catastrophic complications of IE and broadens the understanding of its complication spectrum.