Unusual Presentation of Tuberculosis as a Splenic Mass

Abstract

Tuberculosis is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. Tuberculosis is mostly seen in immuno-compromised individuals, such as those with acquired immune deficiency syndrome or malignancies. Here we report a case of a spleen tuberculoma in a 29-year-old male patient with no known immune deficiency. He first presented with abdominal pain, and subsequent ultrosonographic examination revealed a splenic lesion of 10 cm in diameter. A computerized tomography scan of the abdomen confirmed the presence of a solitary, hypodense, septated cystic lesion. Lack of evidence supporting the presence of a splenic infection or a primary/metastatic malignancy prompted explorative surgery where a septated abscess formation was discovered and splenectomy was performed. Histopathological examination revealed granulomatous inflammatory changes with Langerhans-type giant cells, which are consistent with tuberculosis. For a period of two months, antituberculosis therapy with four drugs, isoniazid, rifampicin, pyrazinamide, and ethambutol, was carried out. Pyrazinamide and ethambutol were quitted at the end of two months. Theraphy with isoniazid and rifampicin was planned for an additional 10 months. We would like to call attention to yet another atypical presentation of extrapulmonary tuberculosis. spleen tuberculosis; abdominal tuberculosis; splenic abscess

A Case of Mass-Forming Splenic Tuberculosis: MRI Findings with Emphasis of Diffusion-Weighted Imaging Characteristics

“…The more frequent form is the disseminated or miliary type involving the spleen which often is related to immunosuppressed condition but also is observed in immunocompetent patients (5, 11). The isolated type is rare and has been reported to be more associated with HIV infection (5, 12). Our patient did not have a specific HIV antibody test, but with regard to the normal laboratory results listed previously, the possibility of concurrent HIV infection is less likely.…”

“…If the nodules are below the resolution capability of imaging techniques, they could manifest as simple splenomegaly (10). Macronodular splenic tuberculosis is rare and could manifest as a singular abscess or multiple large nodules (12). If it does manifest as a localized mass as in our case, differentiation from other solid mass lesions is not always easy (12, 15).…”

A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula

“…9 As most patients with splenic tuberculosis may have disseminated disease, a few controlled trials of treatment in patients with extra-pulmonary tuberculosis strongly suggest a 12-month regimen, with prolonged treatment if deemed necessary. 13,14 In contrast, one study showed very slight improvement between imaging studies at 12 and 24 months although anti-tuberculous treatment was continued for over 24 months due to unresolved lesions. 13 The optimal duration of treatment for splenic tuberculosis is undetermined: in our case, further treatment was discontinued after nine months of anti-tuberculous medication since most of the lesions had disappeared.…”

Atypical spleen tuberculosis in a melanoma patient accidentally detected during a 18F‑FDG PET/CT study: Case report

“…However several authors describe in their work splenic tuberculosis. Dede et al (15) described the case of a 29-year-old patient with widespread abdominal pain worsening for 6 mo. In performed exams showed enlarged, thick walled centrally necrotic mass lesion at the upper pole of the spleen.…”