Diffuse Calcifications of the Spleen: A Novel Association with Systemic Lupus Erythematosus

Objectives: While anatomical and physiological changes in the spleen are reported in systemic lupus erythematosus (SLE), a complex autoimmune disease that can affect most organ systems, calcifications have not been described as a characteristic feature. We report 4 lupus patients with extensive splenic calcifications with no apparent cause except for their primary disease. The relevant literature on calcifications of the spleen in SLE is also reviewed. Methods: Four lupus patients with extensive splenic calcifications are described, identified by radiologists at 2 large urban academic centers. In addition, the relevant literature was reviewed (PubMed search 1947 through May 2010) using the following terms: "lupus," "spleen," and "calcified," "calcification," "calcifications," or "microcalcifications." English-language case reports and series were selected. Results: Four lupus patients were found to have a unique pattern of splenic calcifications. The age range was 36 to 73 years. Two of the patients were women, and 1 of these had SLE and limited systemic sclerosis. On reviewing the literature, 6 additional cases of lupus and splenic calcifications were found, 1 of which had pathologic assessment of the spleen on autopsy. The incidence of infection was apparently not increased in affected patients. Conclusions: A unique pattern of calcifications of the spleen may be found in lupus patients, which can suggest the diagnosis of the underlying connective tissue disease. Whether splenic calcification can predispose to hyposplenism remains to be determined. While the exact significance of diffuse splenic calcification is still unknown, this unique radiologic finding may be a result of the disease process itself.