Splenic Tuberculosis--Case Report

The authors advance the case of a patient aged 42, with cardiovascular disorders who is hospitalized for non-specific, but persistent symptomatology: asthenia, fatigability, dyspnoea, night sweats. The clinical (splenomegaly), abdominal ultrasonographic (splenic hypo-echogenic lesions) and computed tomographic (splenic hypo-dense lesions) elements lead to a splenic disorder, but the association of intra-thoracic and intra-abdominal adenopathies(CT revealed) raises suspicion of a chronic lymphoproliferative syndrome. Splenectomy by open approach is performed and the surprise comes from histopathology: splenic tuberculosis. Clinical, diagnostic and therapeutic aspects of tuberculosis with splenic localization are presented.

A rare presentation of splenic tuberculosis with a pseudocyst

Splenic tuberculosis is an unusual manifestation of extrapulmonary tuberculosis, especially in immunocompetent hosts. It often poses diagnostic difficulties as microbiological confirmation is not easy. In this case report, we describe a case of pseudocyst of the spleen due to tuberculosis, which is a rare clinical presentation with only one case having been reported previously. A 24-year-old immunocompetent woman presented with pain in the abdomen, vomiting and fever. On evaluation the patient was found to have a cyst arising from the spleen. Splenectomy was performed. Pathological examination of the specimen revealed a pseudocyst with granulomas and giant cells consistent with tuberculosis. Cyst fluid analysis revealed lymphocyte predominance with high adenosine deaminase levels. The patient was started on 6 months of antituberculous therapy postoperatively. On follow-up, the patient was found to have gained weight and showed signs of well-being.

Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report

Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mmc (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the patient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.

[Tuberculosis of the spleen--very rare site of extrapulmonary TB]

The extrapulmonary tuberculosis (TB) includes all the sites excepting lung, its origin being in the hematogenous disseminating foci within the main infection. The case of a woman, aged 36, is presented suffering of second degree obesity and type II diabetes mellitus under diet. She was admitted in the Surgery Clinics I of Emergency "Floreasca" Hospital (October 21, 2008) for discontinuous pains, relatively strong in the left hypocondrium, vesperal fever, perspirations, symptoms being present for 5 months. The investigations carried out before and after the admission show the presence of a splenomegaly (stage I-WHO), the absence of hypersplenism, portal hypertension, or other objective elements--excepting those mentioned at admittance--as well as the imaging changes (thoracic abdominal CT: spleen with an axis of 17 cm length, multiple solid hypodense lesions with a diameter of 5 cm). The surgical intervention is undergone (laparoscopic splenectomy). The morphological-pathological diagnosis was tuberculosis of the spleen. Considerations are made on this TB rare site.

[Spleen and medullary tuberculosis]

Spleen is a rare extra-pulmonary tuberculosis manifestation. The spleen tuberculosis is caused by the blood derivative dissemination of mycobacteria. The symptoms can suggest a hematological disease, but it is difficult to make a diagnosis, especially when there are no pulmonary changes. The case of a 27-year-old woman with unclear etiology bone marrow hypoplasia was presented. The patient experienced: fever, body weight loss, pancytopenia and spleen enlargement with numerous focal echographic changes. The splenectomy revealed in a histopathologic examination productiva caseosa tuberculosis. The bone marrow trepanobiopsy revealed as well tuberculosis changes. The antimycobacteria treatment caused an improvement of the clinical state and the regression of symptoms.

Magnetic resonance imaging for multiple macronodular localized splenic tuberculosis

Splenic tuberculosis is usually associated with disseminated miliary tuberculosis; it typically exhibits a multiple micronodular form. We report on magnetic resonance imaging findings of an extremely rare case of multiple macronodular splenic tuberculosis without extrasplenic involvement. The nodules showed hypointensity on T(2)-weighted images and gradual peripheral enhancement with complete fill-in. These findings are consistent with observations in disseminated splenic tuberculosis, except for the nodule and spleen sizes.

Isolated tubercular splenic abscess in an immunocompetent child

Splenic abscess is an uncommon entity in children, more so of tubercular etiology in immunocompetent patients. The few cases reported have usually revealed solitary abscesses in the spleen. We present a case of a 12 year-old immunocompetent girl who presented with fever and pain abdomen and was detected to have multiple tubercular abscesses in the spleen in the absence of any other focus of tuberculosis.

Tubercular splenic abscess in an immunocompetent patient--a rare entity

Tubercular splenic abscess is an uncommon entity. It has been reported in association with immunodeficiency states. Tubercular splenic abscess in an immunocompetent patient is extremely rare. A 24 year old female who had already received a complete course of anti-tubercular therapy (ATT) for pulmonary tuberculosis was diagnosed as having tubercular splenic abscess. She was successfully managed by performing splenectomy. Operative findings and histopathological examinations confirmed the diagnosis.

[Splenomegaly and splenic pseudotumor due to tuberculosis: six new cases]

INTRODUCTION

Splenic tuberculosis is rare. The aim of this study was to remind diagnostic problems in this disease, and to evaluate the value of surgery in its management.

MATERIAL AND METHODS

Retrospective study of data of six patients (three male and three female, whose mean age was 50 years) admitted in surgical department from 1980 to 2000 for splenic tuberculosis.

RESULTS

In six cases, symptoms were poorly specific; splenomegaly and anemia were constant. In imaging studies, splenomegaly was homogeneous in four cases and heterogeneous in two. Diagnosis of tuberculosis was done without need for splenectomy in four patients. Five patients were operated on: two had diagnostic laparotomy without splenectomy, two underwent diagnostic splenectomy and one had splenectomy indicated for splenic abcess refractory to medical treatment. Four of the five operated patients recovered. The two other patients were lost of follow-up.

CONCLUSIONS

In our experience, surgery is useful in diagnosis and treatment of splenic tuberculosis.

Laparoscopic intervention in resistant hepatosplenic tuberculosis presenting as pyrexia of unknown origin

Hepatosplenic tuberculosis (HST), rarely encountered in surgical practice, is seen in-patients with disseminated tuberculosis. A 20-year-old female presenting with pyrexia of unknown origin (PUO) was subsequently diagnosed to have lymph-nodal tuberculosis with involvement of liver and spleen. Despite anti-tuberculosis treatment (ATT) for 3 months, clinical improvement did not occur and fever persisted. Laparoscopic splenectomy and drainage of the hepatic cold abscess were done with favorable results. Smear for acid fast bacilli (AFB), culture for Mycobacterium tuberculosis and histopathological examination (HPE) established the diagnosis of tuberculosis (TB).

The pattern of indications and complications of splenectomy in Eastern Saudi Arabia

OBJECTIVE

The indications for splenectomy have changed over the past decade. Trauma and hematological diseases are emerging as common indications since the early eighties of the last century. This study looks at the pattern of indications and complications of splenectomy at Dammam Central Hospital, Dammam, Eastern Province, Kingdom of Saudi Arabia.

METHODS

A retrospective study of all patients who underwent splenectomy at Dammam Central Hospital over the 5-year period (1996-2000).

RESULTS

There were 55 patients (47 males and 8 females) who underwent splenectomy over the study period. The mean age was 57.5 (range 4-65) years. The most common indication was trauma (43.6%) followed by hematological reasons (25.5%), which were mainly in sickle cell disease (SCD) patients (N=9). Splenic sequestration crises were the most common indication in SCD patients (77.7%). The mean weight of the excised spleen was 882.7 (range 85-1350) grams. There were 16 (29%) postoperative complications mostly encountered in patients with portal hypertension (46.2%). There were 2 deaths (3.6%) as a result of pulmonary embolism in a trauma patient and multi-organ failure in SCD. There was no reported postsplenectomy sepsis after a follow-up period of 18-72 months.

CONCLUSION

The most common indication for splenectomy in Dammam is abdominal trauma, followed by hematological diseases. Splenectomy in adult SCD population is uncommon. Conventional splenectomy has 29% complication rate especially in patients with portal hypertension. This calls for rapid introduction of minimally invasive approach to reduce the morbidity associated with open splenectomy.

Splenic tuberculosis presenting as hypersplenism

A 9-year-old girl with a 5-6-month history of abdominal distension and fever was found to have massive splenomegaly with features of hypersplenism. Apart from a strongly positive Mantoux test, all investigations for massive splenomegaly proved negative. Splenectomy was carried out and histopathological examination of the spleen revealed granulomatous lesions suggestive of tuberculosis. The child improved after splenectomy and anti-tuberculous therapy and is doing well on follow-up. Splenic tuberculosis should be considered as an unusual cause of massive splenomegaly and hypersplenism.

Splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum: report of a case

We report a patient with splenic vein occlusion (SVO) secondary to tuberculosis. A 17-year-old male patient with mild epigastric pain and splenomegaly was found to have gastric varices by gastroscopy, and SVO by selective angiography. At operation, the splenic vein was occluded by hard fibrous tissue at the splenic hilum, and thus a splenectomy was performed. A microscopic examination of the tissue revealed caseous necrosis surrounded by epithelioid cells and Langhans-type giant cells. Although there were no other findings suggesting intestinal tuberculosis, it seemed that tuberculous lymphadenitis of the splenic hilum most likely caused the occlusion of the splenic vein. Because specific tests for tuberculosis were negative in both immunohistochemical staining for bacille Calmette-Guérin and polymerase chain reaction of DNA for Mycobacterium tuberculosis, the time of infection was assumed to have occurred a long time before. SVO can sometimes be seen in pancreatic diseases, but this patient with tuberculosis appears to be the first such reported case in the English literature.

Tuberculosis: a rare cause of splenic abscess

Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.

Tuberculoma of the spleen: a rare but important clinical entity

Tuberculoma of the spleen has been an extremely rare entity during the last decades in the Western world. We describe a case in a young, HIV-negative woman who was evaluated for fever of unknown origin. The workup was initially negative, and she was treated successfully with steroids and nonsteroidal anti-inflammatory analgesics. Recurrence of the fever and an abnormal CT of the abdomen lead to an exploratory laparotomy, which revealed a subcapsular caseous material containing splenic abscess. The very few cases reported in the literature, and the increasing incidence of extrapulmonary tuberculosis due to the alarming numbers of immunodeficient patients that a surgeon may encounter are also discussed.

Splenic abscess: a diagnostic and therapeutic challenge

The records of five patients treated in our department for splenic abscess are analysed and the literature is reviewed. Computed tomography revealed the correct diagnosis in all patients, while clinical presentation was often nonspecific. Spleen-preserving management was possible in two patients (40%). Outcome was uneventful for four patients. One patient with a splenic abscess caused by Mycobacterium tuberculosis and acquired immunodeficiency syndrome, died 4 months after splenectomy from sepsis. We discuss the clinical presentation of splenic abscess, its diagnostic approach, and treatment. Additionally, we studied whether spleen-preserving management is feasible or not.

Response to antituberculous chemotherapy after splenectomy

A case of a 17-year-old Indian male with disseminated tuberculosis is reported. While on chemotherapy, he was detected to have splenic abscesses. The patient remained unresponsive to antituberculous drugs until a splenectomy was performed.

Primary tubercular abscess of the spleen

A 12-year-old boy with localized tubercular abscess of the spleen is presented. The diagnosis was established on histopathologic examination. Treatment consisted of splenectomy and postoperative antitubercular therapy.

[Isolated splenic tuberculosis]

A case of splenic tuberculosis is reported. The patient was a 79-year-old man who was admitted to the Tokyo Metropolitan Geriatric Hospital because of high fever and loss of body weight. Several finger-tip sized superficial lymph nodes were palpable in bilateral inguinal regions. The intermediate PPD skin test was positive. However, there was no evidences of active tuberculosis on the chest roentgenogram. The computed tomogram of the abdomen showed moderate enlargement of the spleen with multiple low density areas and several swollen lymph nodes in the para-aortic region. Although a lymph node of the inguinal region was resected for the pathologic examination, it showed no specific changes. In order to obtain a final diagnosis, laparotomy was performed. The spleen was markedly enlarged and nodular in appearance. No abnormal findings were observed in the other abdominal organs. Splenectomy was carried out. Numerous yellowish nodules, varying from 0.1 to 5 cm in diameter, were observed on the cut surface of the resected spleen (20 x 20 x 8 cm, 700 g). The bacteriologic examination revealed acid-fast bacilli. The fever subsided after splenectomy and following antituberculous therapy. Recently, isolated tuberculosis of the spleen has become very rare. Since 1965, only six cases in five reports can be found in the English, French and German literature. The present case is considered to be one such very rare cases of tuberculosis. Although splenic tuberculosis is rare at the present time, splenic tuberculosis should be included in the differential diagnosis of fever of unknown origin with splenomegaly.

[Diagnosis and treatment of solitary tuberculosis of the spleen]

Solitary tuberculosis of spleen is a rare case in abdominal organ tuberculosis, three cases were reported and we discussed the nomination diagnosis, classification, treatment and some important points that surgeons should notice during the operation. It is suggested that according to the pathological classification we classified solitary tuberculosis of spleen into miliary, caseous and calcified type. This would help us to determine the stage and the treatment of the disease, we also emphasize that B-scan is important to the diagnosis of the disease and splenectomy is preferable in treating solitary tuberculosis of caseous type of spleen.

[Chronic splenic tuberculosis. Description of a case]

The authors report a case of chronic splenic tuberculosis. They underline the diagnostic difficulties, notwithstanding the remarkable progresses in radiological technics, essentially related to the rarity of this tubercular site and they outlined the exact surgical indication to the splenectomy.

Primary splenic tuberculosis in transplant candidates

Caseous granulomatous lesions, consistent with tuberculosis, were found in the spleen in two of our renal transplant candidates. There was no clinical evidence of tuberculosis in either patient. Only one patient had a positive tuberculin skin test whose chest film showed hilar calcifications suggestive of healed granulomatous disease. Because of this incidental finding in the spleen, both patients were placed on antituberculous therapy. There has been no evidence of active tuberculosis in either patient despite the use of usual doses of immunosuppressive drugs.