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PubMed2001

Splenic tuberculosis presenting as hypersplenism.

A 9-year-old girl with a 5-6-month history of abdominal distension and fever was found to have massive splenomegaly with features of hypersplenism. Apart from a strongly positive Mantoux test, all investigations for massive splenomegaly proved negative. Splenectomy was carried out and histopathological examination of the spleen revealed granulomatous lesions suggestive of tuberculosis. The child improved after splenectomy and anti-tuberculous therapy and is doing well on follow-up. Splenic tuberculosis should be considered as an unusual cause of massive splenomegaly and hypersplenism.

Child↗
PubMed2006

Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient.

We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm(3)), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.

AIDS-Related Opportunistic Infections↗
PubMed2000

Isolated splenic tuberculosis presenting with pyrexia of unknown origin.

We report a case of a 62-y-old man who presented with fever, malaise and weight loss. He was diagnosed with pyrexia of unknown origin due to tuberculosis of the spleen. Combination anti-tuberculous therapy was administered and fever gradually subsided after 6 weeks. A 12-month course of anti-tuberculous treatment would appear to be appropriate for the treatment of most patients with splenic tuberculosis.

Antitubercular Agents↗
PubMed1999

Primary splenic tuberculosis in a patient with nasal angiocentric lymphoma: mimicking metastatic tumor on abdominal CT.

Tuberculosis may be difficult to diagnose when it presents in an uncommon extrapulmonary site. The authors report a case of splenic tuberculosis mimicking metastatic tumor on computed tomography in a 60-year-old woman who had been treated with combination chemotherapy for nasal angiocentric lymphoma. Diagnostic splenectomy revealed multiple necrotic masses in the spleen, which were consistent with caseating granulomas microscopically. Diagnosis was confirmed by positive cultures in Lowenstein medium, which grew typical Mycobacterium tuberculosis organisms. Following splenectomy, the patient was also treated with a triple-drug antituberculosis regimen with no recurrence of her symptoms.

Diagnosis, Differential↗
PubMed1993

Hemangioma of spleen with spontaneous, extra-peritoneal rupture, with associated splenic tuberculosis--an unusual presentation.

We report a case of unusual presentation of a patient with hemangioma of the spleen. The patient had presented with recurrent gastric hemorrhage and significant weight loss, due to ruptured hemangioma of the spleen and associated splenic tuberculosis. The true nature of the lesions remained a diagnostic dilemma despite complete radiological workup and review of literature.

Adult↗
PubMed1999

Splenic tuberculosis: an unusual sonographic presentation.

Tuberculosis (TB) of the spleen is rare, especially in the immunocompetent. Recently there has been an increase in the incidence of splenic TB, primarily attributable to the raging HIV epidemic. Almost all cases of splenic TB present as multiple hypoechoic foci (< 2 cm) on ultrasonography. We present a case of a large solitary splenic tuberculoma in a middle-aged, non-immunosuppressed female, an employee at the local TB hospital. To the best of our knowledge, only two such cases have been described on ultrasound before. We suggest that, regardless of immune status, splenic TB should be considered as a diagnostic possibility when dealing with the solitary nodules of the spleen, especially when there is a history of exposure to or evidence of tuberculous foci elsewhere in the body.

Diagnosis, Differential↗
PubMed2006

Unusual presentation of tuberculosis as a splenic mass.

Tuberculosis is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. Tuberculosis is mostly seen in immuno-compromised individuals, such as those with acquired immune deficiency syndrome or malignancies. Here we report a case of a spleen tuberculoma in a 29-year-old male patient with no known immune deficiency. He first presented with abdominal pain, and subsequent ultrasonographic examination revealed a splenic lesion of 10 cm in diameter. A computerized tomography scan of the abdomen confirmed the presence of a solitary, hypodense, septated cystic lesion. Lack of evidence supporting the presence of a splenic infection or a primary/metastatic malignancy prompted explorative surgery where a septated abscess formation was discovered and splenectomy was performed. Histopathological examination revealed granulomatous inflammatory changes with Langerhans-type giant cells, which are consistent with tuberculosis. For a period of two months, antituberculosis therapy with four drugs, isoniazid, rifampicin, pyrazinamide, and ethambutol, was carried out. Pyrazinamide and ethambutol were quitted at the end of two months. Therapy with isoniazid and rifampicin was planned for an additional 10 months. We would like to call attention to yet another atypical presentation of extrapulmonary tuberculosis.

Adult↗
PubMed1999

Extra-pulmonary tuberculosis in patients with fever of unknown origin: clinical features and diagnosis.

One hundred twenty-nine patients with extra-pulmonary tuberculosis admitted at the Abbassia Fever Hospital, NAMRU-3 during a seven year period (1991 to 1997) are described. Tuberculous peritonitis was diagnosed in 35 patients, tuberculous lymphadenitis in 32, intestinal tuberculosis in 19, genito-urinary tuberculosis in 14, skeletal tuberculosis in 13, disseminated miliary tuberculosis in 11, and splenic tuberculosis in 5 patients. The clinical picture included fever, and weight loss accompanied by anaemia and an elevated erythrocyte sedimentation rate in all patients.

Adolescent↗
PubMed2006

Co-existence of spontaneous splenic rupture and tuberculosis of the spleen.

A rare case of splenic tuberculosis complicated by splenic rupture is reported. A 73-year-old man, hospitalized for peptic ulcer bleeding, presented in oligemic shock, was transferred to the operating room. Hemoperitoneum, due to rupture of an enlarged spleen was detected. The pathology revealed splenic tuberculosis. He had an uneventful recovery. Postoperatively, he received a combination of anti-tuberculous therapy for 6 months.

Aged↗
PubMed1994

Miliary tuberculosis with splenic rupture: a fatal case with hemophagocytic syndrome and possible association with long standing sarcoidosis.

A fatal case of miliary tuberculosis complicated by splenic rupture and reactive hemophagocytic syndrome is presented. A 42 yr old Indian patient with a 7 yr history of sarcoidosis developed miliary tuberculosis and hemophagocytic syndrome after steroid therapy. A ruptured enlarged spleen with hemoperitoneum was detected at autopsy. This case highlights the need to consider the occurrence of tuberculosis in patients with sarcoidosis, especially after steroid therapy. Yellow bodies (Hamazaki-Wesenberg bodies), commonly but not exclusively found in sarcoidosis, were identified within the retroperitoneal lymph nodes in this case.

Adult↗
PubMed2004

[Splenomegaly and splenic pseudotumor due to tuberculosis: six new cases].

INTRODUCTION: Splenic tuberculosis is rare. The aim of this study was to remind diagnostic problems in this disease, and to evaluate the value of surgery in its management. MATERIAL AND METHODS: Retrospective study of data of six patients (three male and three female, whose mean age was 50 years) admitted in surgical department from 1980 to 2000 for splenic tuberculosis. RESULTS: In six cases, symptoms were poorly specific; splenomegaly and anemia were constant. In imaging studies, splenomegaly was homogeneous in four cases and heterogeneous in two. Diagnosis of tuberculosis was done without need for splenectomy in four patients. Five patients were operated on: two had diagnostic laparotomy without splenectomy, two underwent diagnostic splenectomy and one had splenectomy indicated for splenic abcess refractory to medical treatment. Four of the five operated patients recovered. The two other patients were lost of follow-up. CONCLUSIONS: In our experience, surgery is useful in diagnosis and treatment of splenic tuberculosis.

Adult↗
PubMed1995

[Tuberculous splenic abscess in an immunocompetent patient].

Splenic tuberculosis is a rare entity. The case of an 18-year old patient admitted for fever and general malice is described. Echography and abdominal CT showed a hypodense image localized in the spleen. Splenic tuberculosis was diagnosed upon observation of alcohol acid resistant bacilli (AARB) in the biopsy obtained by punction of the abscess. Correct tuberculostatic treatment led to disappearance of the splenic abscess with no further therapeutic measures being required.

Abscess↗
PubMed1998

[Hepato-splenic and peritoneal tuberculosis. A difficult diagnosis].

Peritoneal tuberculosis is a rare extra-pulmonary location of Mycobacterium tuberculosis infection arising in the gastrointestinal tract mostly as a complication of the pulmonary location or seldom as a primary involvement. The authors report the case of a 18-year old girl admitted in 1996 to the Infectious Diseases Department of the Umberto I Hospital, "La Sapienza" State University of Rome for the persistence of fever and dry cough, despite a protracted antibiotic treatment performed in previous hospital admissions for a suspicious diagnosis of a "broncho-pneumonia". As the fever didn't decrease and a pain at the right ilium arose, an anti-tuberculous chemotherapeutic treatment was performed (isoniazid and rifampicin), that improved the state of the patient. The pain was resolved by means of a celioscopic operation, showing the evidence of various white nodes on the peritoneal, hepatic and lienal surfaces; all these pathognomonic signs and the anti-tuberculous chemotherapy confirmed the diagnosis of "hepatic, lienal and peritoneal tuberculosis". The patient was subsequently admitted to our institute, where an anti-tuberculous treatment (isoniazid, rifampicin and pyrazinamide) was performed, which caused a further resolution of the clinical and radiological picture.

Adolescent↗