Successful Immunosuppressive Therapy for Aseptic Abscess Syndrome Presenting with a Fever of Unknown Origin.
Shingo Okamoto, Kazuo Eguchi, Susumu Maruta et al.
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Case in brief
A 70-year-old woman presented with recurrent fever, multiple colonic aphthae, and painful nodules on her limbs. CT showed multiple splenic lesions, and aspiration yielded white purulent fluid, initially suggesting splenic abscesses. Blood and aspirate cultures were negative, and antibiotics were ineffective. The combination of sterile lesions and clinical features led to suspicion of aseptic abscess syndrome (AAS). Corticosteroid therapy was followed by rapid symptom resolution; she remained relapse-free on azathioprine and colchicine maintenance therapy.
What made this case unusual
The splenic lesions yielded purulent-appearing fluid despite negative cultures and lack of response to antibiotics, creating a diagnostic pitfall between infectious abscesses and AAS.
Diagnostic / clinical pearl
When apparent abscesses are culture-negative and do not respond to antibiotics, AAS should be considered in the appropriate clinical context.