Clinical picture: Subphrenic abscess and rupture of the spleen

A 68-year-old female patient was admitted with fever and lassitude. She had a long history of schizophrenia and lived in a psychiatric hospital. She was alert but appeared confused and acutely ill. She could not answer simple questions. Her blood pressure was 90/60 mm Hg, pulse 120/min and temperature 39.2 deg C. The chest was clear but left subcostal tenderness was noted. She had an elevated leukocyte count and C-reactive protein.