Splenic tuberculosis presenting as fever of unknown origin with severe neutropenia

Abstract

Fever of undetermined origin always poses a challenging problem to the physician. Tuberculosis is an important health problem in developing countries. It is mostly seen in immune-compromised patients. And it is one of the common causes of fever of unknown origin. I am reporting a case of a splenic tuberculosis in 48 years old male who is not known of any immune deficiency state, he was presented with 3 weeks history of fever and found to have severe neutropenia and with negative work up for all hematological, rheumatological and malignant causes. A computerized tomography scan of the abdomen confirmed splenic enlargement with multiples hypo dense lesions consist with either splenic infection or splenic lymphoma so exploratory splenectomy was performed. Histological examination revealed granulomatouse inflammation with numerous acid fast bacilli consist with tuberculosis. He was started on four anti-tuberculouse drugs. in less than one week his fever subside with normalization of his neutrophilic count

Isolated splenic tuberculosis with subsequent paradoxical deterioration: a case report

“…Isolated splenic involvement is rare, and is usually reported in immunosuppressed individuals [1–3, 8]. Coley first described TB of the spleen in 1846, referring to an “enlarged spleen secondary to tuberculosis with absent or limited involvement of other organs” [16].…”

“…On the other hand, abdominal CT scan has added value in ruling out involvement of other organs, and has higher diagnostic accuracy than ultrasound which suffers from operator-dependence. CT scan of the abdomen would often show multiple rounded hypodense lesions which may be present in a variety of conditions other than splenic TB [1, 21]. Differential diagnosis of solitary splenic masses that ought to be considered include cysts, haematoma, fungal infection, abscesses, infarcts, vascular tumours, lymphoma and metastatic tumours [8].…”

“…Isolated tuberculosis of the spleen in immunocompetent hosts is rare [1–3]. Splenic involvement is more frequently reported in cases of disseminated tuberculosis following haematogenous spread of Mycobacterium tuberculosis (MTB) and in patients with significant immune suppression [4, 5].…”

“…Splenic involvement is more frequently reported in cases of disseminated tuberculosis following haematogenous spread of Mycobacterium tuberculosis (MTB) and in patients with significant immune suppression [4, 5]. However, there are few reports of isolated splenic tuberculosis worldwide [1, 5–9]. Risk factors associated with tuberculosis (TB) of the spleen include immunosuppression, preceding pyogenic infections, splenic abnormalities, prior trauma to the spleen, sickle cell disease and other haemopathies, and in the immune competent patient where another body site has been infected by MTB [6].…”

Evaluation of Forty-Nine Patients with Abdominal Tuberculosis

“…However, the nodal form was the second most type of ATB. Cases of gastrointestinal and solid organ tuberculosis are less common conditions and are usually found as small series in the literature [8][9][10][11]. It is well known that gastrointestinal TB often involves the ileocecal region.…”