Peliosis of the spleen as an unusual cause of splenic rupture: A case report and a review of literature.

Isolated splenic peliosis is an extremely rare condition characterized by the presence of multiple blood-filled cavities, occasionally resulting in non-traumatic splenic rupture with fatal bleeding. In our case, a 64-year-old man was brought by ambulance due to weakness and abdominal pain without nausea or febrility. On clinical examination, the patient was sensitive to palpation with significant tenderness over the abdomen but no associated features of peritonitis. He collapsed during the imaging examination and became unconscious and asystolic. Cardiopulmonary resuscitation was not successful. The patient died approximately within 2 hours of admission to the hospital. Postmortal examination showed 2800 ml of intraperitoneal blood with clots and a laceration of the lower pole of the spleen. Macroscopic examination of the spleen revealed huge nodular splenomegaly, measuring 21 cm x 19 cm x 5 cm, weighing 755 g. On the cut surfaces, multiple randomly distributed blood-filled cavities ranging from 0,5 to 2 cm in diameter were seen. At microscopic examination, the specimens showed multiple irregular haemorrhagic cyst-like lesions that were not lined by any epithelium or sinusoidal endothelium, consistent with the diagnosis of peliosis lienis. Although the condition is often clinically silent, the forensic pathological significance arises from the differential diagnosis of resultant intraperitoneal haemorrhage and sudden death, mimicking a violent death.

[Undiagnosed Whipple's disease with a lethal outcome]. / Nediagnostikovaná Whippleova choroba s letálnym koncom.

Whipples disease is a rare multisystem disease caused by rod-shaped bacteria Tropheryma whipplei. Although it affects all age groups, the typical patient is a middle-aged white man. The clinical signs are very heterogeneous and depend on the stage of the disease. The most common is abdominal manifestation characterized by weight loss, disability, chronic diarrhea and abdominal pain. Untreated Whipples disease is almost always fatal. We describe probably the first published case of undiagnosed Whipples disease with a lethal outcome in Slovakia, occuring in a 33-year old white man with involvement of the gastrointestinal tract, abdominal lymphatic nodes and brain, who died of bronchopneumonia.