Studies on the Etiology of Splenomegaly of Unknown Origin. (Splenic Mycosis?)

Abstract

Recent reports from widely separated sources indicate a renewed interest in the etiology of primary splenomegaly with cirrhosis of the liver and anemia (Banti's disease). Gibson and Fawcett and Gibson have isolated a streptothrix-like organism (Nocardia) from the spleen which they believe to be the causative agent. Pinoy and Nanta in Algiers and Emile-Weil, Gregoire and Flandrin in Paris and others have cultivated a fungus, Aspergillus, from a high percentage of spleens from cases of splenomegaly with anemia and have applied the terms “splenic mycosis” and “mycotic splenomegaly” to the disease. These views have not been generally accepted. Although Oberling and Jaffe and Hill were convinced that certain thread-like elements found in the siderotic nodules in the spleen were mycotic filaments, in harmony with the interpretations set forth by other investigators, they found the same structures in other diseases as well, f. i., leukemia, sickle cell anemia, etc. They suggested that the fungus was a secondary invader in a previously damaged spleen. Other observers, Gamna, Langeron and da Fonseca and da Area Leao believed the so-called mycelium found in the nodules to be degenerated tissue fibers and that no connection between the fungus and the disease exists. In northern China splenomegaly with cirrhosis of the liver, ascites, anemia and leucopenia is a common disease. A clinical study of this group of cases will be published elsewhere. We have recently had the opportunity of examining 4 spleens and portions of liver from 3 cases of splenomegaly and from 1 case of primary cirrhosis of the liver. The specimens were removed by operation. By inoculating the crushed splenic pulp on Sabouraud's medium we were able to cultivate a fungus from each spleen. Tubes inoculated with portions of liver remained sterile.