Nikhil Prasad Fact checked by:Thailand Medical News Team Aug 27, 2026 29 minutes ago
COVID-19 is widely associated with pneumonia, respiratory distress, and lung injury, but mounting pathological and clinical evidence shows that SARS-CoV-2 can also seriously affect the spleen. This often-overlooked organ can undergo immune-cell depletion, structural deterioration, vascular injury, and potentially devastating infarction.
COVID-19 can quietly damage the spleen through immune-cell loss, inflammation, vascular injury, and potentially dangerous
blood clots
The concern is particularly significant because splenic abnormalities may not produce obvious symptoms. Patients can therefore recover from their respiratory illness without realizing that inflammatory and vascular processes have affected an organ essential for immune surveillance and blood filtration.
The Spleen Is an Important Immune Target
The spleen filters circulating blood, removes damaged cells, detects blood-borne pathogens, and provides an important environment for immune cells, including B and T lymphocytes.
Pathological studies of COVID-19 patients have documented striking splenic abnormalities. Researchers examining spleen tissues have reported lymphocyte depletion, white pulp atrophy, cellular degeneration, necrosis, and evidence of apoptosis.
Some investigations have also detected SARS-CoV-2-related viral material or proteins within splenic tissues, supporting concerns that the organ can become involved during systemic infection.
One study examining spleens and lymph nodes from patients who died with COVID-19 described substantial lymphocyte loss and tissue damage, providing a possible pathological explanation for some of the immune abnormalities observed during severe disease.
These findings are important because destruction or depletion of lymphocytes could interfere with coordinated antiviral immunity. This
Thailand Medical News report highlights why COVID-19 should therefore be viewed as a systemic disease rather than solely as a respiratory infection.
Dangerous Blood Clots Can Cut Off the Spleens Oxygen Supply
Another major threat involves COVID-19-associated coagulation abnormalities. SARS-CoV-2 infection can promote endothelial injury, platelet activation, inflammation, and disruption of normal clotting pathways. Together, these mechanisms can create a prothrombotic environment in susceptible patients.
When a clot obstructs an artery supplying the spleen, part of the organ can lose its blood supply. This produces a splenic infarction, in which oxygen deprivation causes tissue injury and potentially tissue death.
Published case reports have documented both partial and extensive splenic infarctions associated with COVID-19. Particularly concerning are reports suggesting that infarction can sometimes emerge after the more recognizable respiratory phase of infection.
Symptoms can include left upper abdominal pain, tenderness, fever, nausea, or pain radiating toward the left shoulder. However, smaller infarctions may cause nonspecific symptoms or potentially escape immediate recognition
.
Severe Cases Can Produce Extensive Splenic Destruction
Complete or near-complete splenic infarction represents an especially serious complication. Imaging in reported COVID-19 cases has demonstrated extensive areas of splenic tissue failing to receive adequate blood flow.
Damaged or infarcted tissue can potentially create additional complications, including hemorrhage, secondary infection, abscess formation, and, rarely, splenic rupture. These complications require urgent clinical assessment because internal bleeding or overwhelming infection can become life-threatening.
The findings also reinforce why unexplained abdominal symptoms during or following COVID-19 deserve attention, particularly in patients with elevated thrombotic risk.
Researchers Have Also Detected Changes in Spleen Size
COVID-19 may affect the spleen differently depending on disease stage and severity.
Imaging studies have reported increased spleen dimensions in some patients during infection. Researchers have proposed that intense immune activation and systemic inflammation could contribute to enlargement, particularly during the early inflammatory response.
Meanwhile, pathological examinations of fatal cases have revealed disruption of normal splenic architecture, including white pulp depletion and alterations involving immune-cell populations.
This apparent combination of enlargement in certain phases and tissue depletion in severe or fatal disease illustrates the complex biological response of the spleen to SARS-CoV-2.
Why Splenic Injury Can Remain Hidden
One difficulty is that splenic damage does not necessarily produce a distinctive warning signal. Abdominal discomfort can easily be overshadowed by fever, coughing, fatigue, shortness of breath, or other manifestations of acute COVID-19.
Clinicians primarily confronting respiratory disease may consequently have little reason to investigate the spleen unless abdominal symptoms, coagulation abnormalities, unexplained anemia, inflammatory changes, or other clinical findings raise suspicion.
Autopsy studies have been especially valuable because they have exposed organ damage that was not always apparent while patients were alive. Histopathological investigations have repeatedly reinforced the systemic nature of severe COVID-19, documenting vascular and inflammatory abnormalities across multiple organs.
There is also evidence that lymphoid tissues can remain biologically important after acute infection. Reports examining viral persistence or recurrence have raised questions about whether tissues such as the spleen can sometimes harbor viral material for prolonged periods, although the clinical significance and frequency of this phenomenon require further investigation.
What the Evidence Ultimately Means
The accumulated findings show that COVID-19 can involve the spleen through several overlapping mechanisms, including immune-cell depletion, lymphoid tissue atrophy, inflammation, vascular dysfunction, thrombosis, and infarction. These abnormalities appear especially relevant in severe disease, while rare case reports demonstrate potentially catastrophic complications.
Importantly, the evidence does not mean every person infected with SARS-CoV-2 develops clinically significant splenic injury. However, persistent or sudden left-sided abdominal pain, unexplained fever, or other concerning symptoms during or after COVID-19 should not automatically be dismissed, particularly in individuals with additional clotting risks.
Greater clinical awareness of extrapulmonary complications could help identify uncommon but serious splenic involvement earlier, while continued research is needed to determine its prevalence, long-term immune consequences, relationship with disease severity, and significance after apparent recovery.
References:
https://linkinghub.elsevier.com/retrieve/pii/S0344033821002715
https://www.sciencedirect.com/science/article/pii/S1930043322000930
https://www.sciopen.com/article/10.37015/AUDT.2023.230056
https://linkinghub.elsevier.com/retrieve/pii/S2405469021001576
https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2025.1645378/full
https://www.ovid.com/jnls/md-journal/fulltext/10.1097/md.0000000000039194~splenic-abscess-secondary-to-covid-19-acute-infection-a-case
https://www.wjgnet.com/1007-9327/full/v27/i35/5919.htm
https://link.springer.com/article/10.1007/s42399-021-01029-5
https://www.cureus.com/articles/92000-histopathological-findings-in-covid-19-cases-a-systematic-review#!/
https://www.cureus.com/articles/217804-splenic-surprise-investigating-a-case-of-splenic-infarct-as-an-isolated-covid-19-manifestation#!/
https://linkinghub.elsevier.com/retrieve/pii/S2590170220300297
https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2025.1645378/full
https://www.clinicalimaging.org/article/S0899-7071(21)00196-0/fulltext
Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/long-covid
Share
Tweet
Share
