Splenic infarction, due to oral contraceptiveA 45-year old female with no significant past medical history presented with left upper quadrant pain for a duration of one day, progressive in nature, aggravated with cough, relieved with bending forward, associated with 2 episodes of vomiting, containing food particles. Not associated with fever/ chills/ rigors/ trauma / weight change/ shortness of breath/ urinary/ bowel complaint. Medications at home significant only for oral contraceptives. Patient gave a history of smoking 5-6 cigarettes per day.
> B/P:139/97mmHg, Pulse:100/ min, RR: 20, SPO2:100% on room air, Temp: 98.3
> On Examination: P/A: Soft, tender over the left quadrant - diffusely, no guarding / rigidity. No organomegaly, BS heard in all 4 quadrants.
> Labs reviewed - normal. CT Abdomen: Splenic infarction versus infection versus neoplasm. Infarction favored due to the sharply demarcated margins of splenic lesion.
> Possible causes for splenic infarct; myelofibrosis, sickle cell disease, hypercoagulable state, malignancy, infectious mononucleosis were ruled out.
> The probable cause for this patient's splenic infarct was considered to be the oral contraceptive pill in conjunction with smoking.
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