Open splenectomy for Varicella zoster induced spontaneous splenic rupture.

INTRODUCTION: Here we present a case of atraumatic splenic rupture secondary to varicella infection requiring emergency splenectomy. The presentation was as would be expected for epstein barr virus (EBV) related splenic injury, which is well documented in the literature. Dermatological findings however suggested varicella zoster, and viral serology subsequently confirmed the diagnosis. PRESENTATION OF CASE: A young Romanian male presented to the emergency department with peritonism without preceding trauma. Free fluid on USS was aspirated as frank blood and cross-sectional imaging demonstrated a ruptured spleen. He underwent emergency splenectomy and recovered well. During his presentation he was noted to have an erythematous rash with different rates of evolution raising the suspicion for Varicella Zoster. This was subsequently confirmed on viral serology. DISCUSSION: A number of precedents have been identified for spontaneous splenic rupture, however Varicella Zoster has only been reported a handful of times. A number of surgical options are available for splenic rupture, and guidelines exist for traumatic splenic injury. There is limited guidance on the most effective surgical management for spontaneous splenic ruptures with haemodyamic compromise. CONCLUSION: Atraumatic splenic rupture should be considered as an important differential in those presenting with abdominal pain and peritonism without a history of preceding trauma. Haematological and infectious diagnoses should be sought to identify causation for the splenic rupture.

Unusual association between cardiac, skeletal, urogenital and renal abnormalities.

We present a 33-year-old woman with an array of congenital abnormalities. She has been diagnosed with polycystic kidney disease (PCKD) with no detectable mutations in PKD1 or PKD2, spina bifida occulta, thoracic skeletal abnormalities, a uterus didelphys and a patent foramen ovale (PFO). There are several associations reported in the literature that include abnormalities similar to the patient's, but none describe her presentation in its entirety. The MURCS association is characterised by (MU)llerian duct aplasia, (R)enal dysplasia and (C)ervical (S)omite anomalies and goes some way in explaining these condition. Patients with both MURCS and PCKD have not been described in current literature. Through this report, we hope to bring a potential diagnosis to light and provide the patient with an improved understanding of her health.