Pulmonary and Peritoneal Tuberculosis with Tubercular Splenic Abscess

Abstract

Splenic abscess is uncommon, with an incidence of 0.14% to 0.7% in autopsy-based studies. The most common pathogen of splenic abscess in Taiwan is Klebsiella pneumoniae; Mycobacterium tuberculosis is very rare as a causative agent in an immunocompetent patient. We report a 76-year-old woman with active pulmonary tuberculosis who presented with left upper quadrant abdominal pain associated with fever for several days. Computerized tomography scan of the abdomen revealed multiple low density wedge-shaped lesions in the upper and lower portions of the spleen. Tubercular splenic abscess was confirmed by histopathological examination of the excised spleen. Pulmonary tuberculosis was diagnosed via positive sputum acid-fast smear and culture. Tubercular splenic abscess should be on the list of differential diagnoses of an active pulmonary TB patient who presents with left upper quadrant pain and fever. Early anti-tuberculosis treatment should be started and splenectomy reserved for those with an unsatisfactory response or complications, so as to prevent mortality.