Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass: A case report

Figure 1 Initial abdominal computed tomography and magnetic resonance imaging findings. A: Post-contrast phases of abdominal computed tomography showed a 6 cm-sized hypodense mass with peripheral enhancing rim in the spleen; B: T1-weighted abdominal magnetic resonance imaging showed a 6 cm-sized heterogeneously hypointense splenic mass; C: T2-weighted image showed heterogeneous hyperintense signal of this lesion; D: Gadolinium-enhanced T1-weighted image showed peripheral enhancement and a central hypo-enhancing lesion.

Figure 2 Endoscopic ultrasound finding of the splenic mass. A: Endoscopic ultrasound showed a well-demarcated, heterogeneously hypoechoic mass without evidence of necrosis in the spleen; B: Endoscopic ultrasound-guided fine needle biopsy using a 22G needle was performed.

Figure 3 Abdominal computed tomography and magnetic resonance imaging at the readmission. A: Abdominal computed tomography revealed a 7 cm-sized low-density lesion; B: T1-weighted magnetic resonance imaging (MRI) revealed a 7cm-sized hypointense mass with a lower signal compared to the initial MRI; C: T2-weighted MRI revealed much higher signal intensity of this lesion compared to the initial MRI with non-enhancing debris or necrotic portions inside; D: Gadolinium-enhanced T1-weighted image revealed a much lower signal lesion with minimal peripheral enhancement suspecting a capsule development, suggestive for abscess formation.

Figure 4 Gross and microscopic findings of the resected splenic mass. A: Laparoscopic splenectomy showed about 6 cm-sized mass with central necrosis and abscess formation; B: Microscopic findings showed diffuse large B-cell lymphoma (hematoxylin-eosin staining, × 200).

Figure 5 ¹⁸F-fluorodeoxyglucose-positron emission tomography after splenectomy showed no other organ involvement of lymphoma.