Splenic tuberculosis presenting as pyrexia of unknown origin.
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Caseous granulomatous lesions, consistent with tuberculosis, were found in the spleen in two of our renal transplant candidates. There was no clinical evidence of tuberculosis in either patient. Only one patient had a positive tuberculin skin test whose chest film showed hilar calcifications suggestive of healed granulomatous disease. Because of this incidental finding in the spleen, both patients were placed on antituberculous therapy. There has been no evidence of active tuberculosis in either patient despite the use of usual doses of immunosuppressive drugs.
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The authors report a case of chronic splenic tuberculosis. They underline the diagnostic difficulties, notwithstanding the remarkable progresses in radiological technics, essentially related to the rarity of this tubercular site and they outlined the exact surgical indication to the splenectomy.
We report a case of abdominal tuberculosis with predominant splenic involvement and hypersplenism in a patient without any risk factor for tuberculosis. We review the literature and emphasize the unusual splenic involvement, the difficulties in the specific diagnosis and the therapeutic strategy. We conclude that this disease should be included in the differential diagnosis of hypersplenism.
Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis, without any HIV infection. All patients had focal splenic lesions in the form of scattered hypoechogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach.