P105 Unusual presentation of tuberculosis as splenic nodules in a patient with Crohn's disease

Abstract

Background: Increased risk of tuberculosis (Tb) during tumor necrosis factor alpha (TNFa) antagonist therapy is one of severe problems in patients with Crohn’s disease. It is usually presented as pulmonary manifestation, sometimes miliary Tb. But, extra-pulmonary Tb has been rarely reported in case of Crohn’s disease. Here in, we present a case of unusual presentation of Tb in a patient with Crohn’s disease after antiTNFa therapy. Case report: A 21-year-old male was diagnosed as Crohn’s disease, two years ago. Oral corticosteroid therapy was initial treatment. He complained a nausea after azathioprine administration and oral mesalazine could not improve the Crohn’s disease. Because of disease progression, anti-TNFa therapy was started one year ago. Tb Screening test was negative at that time. Crohn’s disease was improved after infliximab induction. After 6 month, he admitted to hospital due to right lower abdominal pain. Any other symptom except abdominal pain was not shown and chest X-ray was unremarkable. There was no evidence of appendicitis or Crohn’s disease aggravation in abdominal CT. But, multiple nodules were shown in spleen (Figure 1), which were suspected Tb, fungal infection, or lymphoma.