A Case of Escherichia coli Bacteremia Presenting with Multiple Splenic Abscesses: A Masquerading Presentation

Splenic abscesses are a rare manifestation and result from Escherichia coli (E. coli) occurs mainly by hematogenous dissemination. We report a case of a diabetic male who presented with an episode of presyncope, malaise, and mild fever. Initial workup revealed anaemia, elevated inflammatory markers, and E. coli bacteremia. In the presence of splenic abscesses and absence of obvious septic foci, delayed advanced imaging confirmed the source of septicemia as the renal abscess. He was treated with a prolonged course of intravenous antibiotics, leading to complete resolution of abscesses and normalization of inflammatory markers. This case highlights the diagnostic challenge in finding the aetiology of septic focus when splenic abscesses complicate the clinical picture, the importance of taking cultures, early initiation of appropriate antibiotics in suspected sepsis in high-risk populations and usage of multi-modal imaging in complicated cases despite non-specific clinical presentation.