Splenic Infarction with Myocardial Injury in a Diabetic Patient: A Case Report

Figures & data

Figure 1 Localized high-density calcium deposition was observed in the aortic arteries (A) and coronary arteries (B). The white arrow in (A) shows the calcification in the artery wall of aorta; the white arrow in (B) indicates the calcification in coronary artery wall.

Figure 2 (a) The ECG showed sinus rhythm (HR:98 bpm), frequent atrial premature beats occurring in pairs, and some exhibiting a biphasic rhythm. (January 23, 2023 14:34:13); (b) the ECG showed sinus rhythm (HR 132 bpm), partial short-term ventricular tachycardia, and irregular intra-chamber conduction (January 30, 2023, 10:28:29); (c) the ECG showed rapid atrial fibrillation and ST segment depression (ST (I II III aVL aVF horizontal depression ≥ > 0.05 mV). (January 30, 2023 13:40:13); (d) a bedside chest X-ray revealed decreased lung transparency on the left and increased lung texture on January 30, 2023; “R”: right side of the patient; (e) the ECG showed rapid atrial fibrillation (HR: 177 bpm) with ST-T changes (ST-II III V4 V5 V6) horizontally inclined, upward and downward > 0.05 mV T (I) wave low and flat). (January 30, 2023 19:11:23); (f) the ECG showed sinus rhythm (HR: 87 bpm), frequent atrial premature beats occurring in pairs, and a T wave at a low level. (February 1, 2023, 16:17:58).

Table 1 Dynamic Evolutions in This Patient’s Laboratory Tests Following Hospitalization

Date	Jan 23	Jan 24	Jan 28	Jan 30 AM	Jan 30 PM	Jan 31 AM	Jan 31 PM	Feb 1	Feb 4	Feb 8	Feb 11	Reference Range
Inflammatory-related
White blood cell (WBC *10^9/L)	9.47	4	11.47			28.46	33.06	25.64	11.98	9.9		3.5–9.5
Neutrophil (N *10^9/L)	7.12	3.53	10.16			26.91	31.22	25.15	10.26	8.36		1.8–6.3
Lymphocyte (L*10^9/L)	1.03	0.38	0.63			0.84	0.79	0.25	0.54	0.99		1.1–3.2
Monocyte (M *10^9/L)	1.01	0.08	0.61			1.2	0.94	0.42	1.02	0.52		0.1–0.6
Red blood cell (RBC *10^12/L)	3.74	2.99	3.72			4.43	4.39	3.91	3.58	3.33		3.8–5.1
Hemoglobin (Hb, g/L)	122	98	121			146	143	128	117	111		115–150
Platelet (PLT *10^9/L)	209	176	290			325	298	242	220	213		125–350
C-reactive protein (CRP mg/L)	41.93	51.9	1.5			75.93	74.68	43.64	4.93	29.65		<10
Procalcitonin (PCT mg/L)	0.13	0.11				10.97	16.96	8.17	0.79	1.88		0.0–0.5
Interleukin-6 (IL-6 pg/mL)		1.5										<7
Glucose-related
Glycated hemoglobin A1C (HbA1C %)	7.20											4–6%
C-peptide (ng/mL)	1.13											0.8–4.2
Coagulation-related
Fibrinogen (Fg g/l)									2.49	3.6		2.0–4.0
D-dimer (Dd mg/L)	1.6	1.65	4.23	10.75	12.28	18.26	17.35	8.21	2.02	2.31	2.95	≤0.55
Prothrombin time (PT seconds)									13.5	14.8		9–15
Activated partial prothrombin time (APTT seconds)									33.7	35.4		20–45
Cardiac-related
Cardiac troponin I (cTnI ng/mL) GICA	0.21	0.22										0–0.5
Creatine Kinase MB (CKMB ng/mL) GICA	2.64	8.73										0–0.4
Myoglobin	51.8	0.22										0–100
(MYO ng/mL) GICA
N-terminal pro-B-type natriuretic peptide (NT-pro-BNP ng/L)	463.78	323.54										0–450
cTnI (ng/mL) CL				1.29		6.95	6.01	2.17	0.56	0.07	0.05	0–0.06
CKMB (ng/mL) CL				27.2		47.8	32.6	9	3.6	3.3	5	0.0–3.7
MYO (ng/mL) CL				>1000		>1000	>1000	786.4	119.8	69.9	145.7	0.0–73.0
BNP (pg/mL)				15.76		127.84	147.36		82.02	75.48	90.9	0–100
Organ-related
Serum amylase (AMY U/L))					1670	743	545	171	187	130	116	30.0–110.0
Urinary amylase (UMY, U/L)								1822				32–641
Alanine aminotransferase (ALT U/L)	19					268				49		5–40
Aspartate aminotransferase (AST U/L)	23					343				27		0–40
Serum Creatinine (SCr μmol/L)	84.82						167.81	126.34	69.87	68.86		0–35

Figure 3 Dynamic evolutions in this patient’s critical laboratory tests following hospitalization. Inflammatory indexes (white blood cell, WBC; procalcitonin, PCT) and acute cardiac infarction index (TnI) peaked on January 31, 2023. They rapidly declined to approximate baseline levels within four days, which were in accordance with the D-dimer change curve. Changes in serum amylase were significant 48 h after the patient experienced stomach pain and diarrhea five times in one night without fever (from January 30 to February 1, 2023).

Figure 4 Several high-density calcifications in the splenic arteries (A–C), and a wedge-shaped region of low density within the spleen (B and C) were observed on an abdominal CT.