Splenic tuberculosis

Abstract

A 24-year-old Indian man was admitted to our hospital on account of fever and epigastralgia. He lost 16 kg of his weight last year, and had been experiencing night sweats. Abdominal computed tomography (CT) (Figure 1A) and ultrasonography (Figure 1B) showed massive splenomegaly with multiple hypodense cysts, most of which were hypovascular. In addition, a few right upper lung nodules and striatum lymphadenopathy were also noted by chest CT. Blood tests were remarkable for C-reactive-protein (9.2 mg/dl [reference: 0.0-0.3]) and positive result of interferon-gamma-release-assay (IGRA). Bacterial screening (staining and culture of sputum, urine and blood) and serological examinations for HIV, Entamoeba histolytica, visceral leishmaniasis and Echinococcus all yielded negative results. After non-diagnostic bronchoscopy, CT re-examination showed a new osteolytic lesion of the right lower rib with surrounding nodule, from which we finally identified Mycobacterium tuberculosis by culture. We started the 4-drug regimen of anti-tubercular treatment (isoniazid/rifampicin/ethambutol/pyrazinamide). Both his symptoms and splenic lesion resolved completely without splenectomy (Figure 1C). Splenic tuberculosis occurs as part of miliary tuberculosis (Winternitz, 1912Winternitz M.C. Tuberculosis of the spleen.Arch Intern Med. 1912; 9: 680Crossref Scopus (14) Google Scholar), and manifest as isolated splenomegaly with nodules of various sizes, each of which seems to represent granulomas (Gulati et al., 1999Gulati M.S. Sarma D. Paul S.B. CT appearances in abdominal tuberculosis: a pictorial essay.Clin Imaging. 1999; 23: 51-59Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, Batra et al., 2000Batra A. Gulati M.S. Sarma D. Paul S.B. Sonographic appearances in abdominal tuberculosis.J Clin Ultrasound. 2000; 28: 233-245Crossref PubMed Scopus (32) Google Scholar, Akhan and Pringot, 2002Akhan O. Pringot J. Imaging of abdominal tuberculosis.Eur Radiol. 2002; 12: 312-323Crossref PubMed Scopus (145) Google Scholar). Although the splenectomy is the gold standard not only for diagnosis but also for treatment, our case is unique images of therapeutic course of splenic tuberculosis which was successfully treated without surgery. Conflicts of interest (COI): The authors have reported that no potential COI exist with any companies/organizations whose products or services may be discussed in this article. Ethics: We declare that all studies have been approved by the local ethics committee of Tohoku University, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to thank Editage (www.editage.jp) for the English language editing.