Splenic tuberculosis caused by hematogenous pulmonary tuberculosis: a case report and literature review / 中国感染与化疗杂志

Objective To understand the clinical features of splenic tuberculosis. Methods The clinical manifestations, laboratory tests, treatment outcomes of a case of splenic tuberculosis caused by hematogenous pulmonary tuberculosis were analyzed. Related literatures about splenic tuberculosis were also reviewed. Results The patient was a 19-year-old male. Cough, fever, night sweats, and weight loss were the main manifestations. Thoracoscopy revealed tuberculosis and imaging suggested splenic tuberculosis and tuberculosis in multiple body sites. Anti-tuberculosis treatment was effective in improving patient conditions. According to literature review, there are two types of splenic tuberculosis: primary splenic tuberculosis or as part of hematogenous pulmonary tuberculosis.The clinical manifestations of primary splenic tuberculosis are usually atypical. Immune deficiency is a significant risk factor of splenic tuberculosis. The main clinical manifestations of splenic tuberculosis are splenomegaly, fever, digestive system symptoms, and occasionally spontaneous splenic rupture (3/32). Most of the patients with splenic tuberculosis (28/32) were cured or improved by anti-tuberculosis treatment and/or splenectomy. Conclusions The onset of splenic tuberculosis is mostly insidious and clinical symptoms usually atypical. The diagnosis relies on radiographic findings, biopsy and pathological examination. Anti-tuberculosis and selective splenectomy are the effective treatment. The outcome of splenic tuberculosis is good in most patients.

Histomorphological Spectrum of Splenectomy Specimens in a Tertiary Teaching Hospital:A Seven Year Study

Background: Spleen is the largest organ of the mononuclear phagocytic system and is involved in all systemic inflammations, generalized hematopoietic disorders, and many metabolic disturbances. Splenectomy is frequently indicated where diagnosis is already established and the purpose of surgery being largely therapeutic in nature. Objectives: The study aims to highlight the histomorphological patterns in the surgically resected splenectomy specimens received in our centre and to correlate with the clinical indications. Materials and Methods: This was a seven year study of all splenectomy specimens received at histopathology section of Department of Pathology in a tertiary care hospital. All the histopathology slides were reviewed by the authors and the microscopic findings were studied and correlated with clinical data. Results: Twenty two (22) spleen samples were received during the study period with a M:F=1: 1.2 . The age range was 2 years to 60 years. The highest number of splenectomy cases was in the age group of 11-20 years followed by 0-10 years age group. The majority of the cases of splenectomy were indicated for thalassemia (14 cases, i.e. 63.64% of all cases), followed by traumatic rupture and secondary malignancy with 2 cases each (9.09% cases each), one case each for splenic infarct, myelofibrosis, ITP and splenic tuberculosis. Conclusion: Thalassemia was proved to be the commonest indication of splenectomy, followed by traumatic rupture and secondary malignancy in the spleen. Larger studies are needed for better understanding of this important organ and unnecessary splenectomies may thus be avoided

Evaluation of spiral CT in the diagnosis of splenic tuberculosis / 中国基层医药

Objective To investigate whether spiral CT is helpful for the diagnosis of splenic tuberculosis.Methods During the recent six years in our hospital,forty splenic tuberculosis patients diagnosed by spiral CT were enrolled in this study.Combined with pathological biopsy and clinical diagnosis and treatment,the accuracy and clinical effect of spiral CT in diagnosis of splenic tuberculosis were comprehensively analyzed.Results 40 patients received CT test were diagnosed as splenic tuberculosis,and 35 patients with biopsy and clinical diagnosis was consistent with the final diagnosis,with the correct rate of diagnosis 87.5％;Type spiral CT accuracy rate and patients with history of tuberculosis and lesion had obvious correlation (x2 =15.873,23.804,all P ＜ 0.01),and patients'age,gender,tumor size,anemia and erythrocyte sedimentation rate had no significant correlation (x2 =1.429,1.004,0.272,0.147,1.429,all P ＞0.05);35 cases of splenic tuberculosis patients with CT diagnosed showed multiple or diffuse nodular lesions,and the lesion size was about tuberculosis 5 ～ 45 mm.The boundary was not clear,which was characterized by low density and had no obvious enhancement.Conclusion Spiral CT is beneficial for the diagnosis of splenic tuberculosis with important clinical value.

Rituximab for Rheumatoid Arthritis Following TNF-alpha Inhibitor Associated Splenic Tuberculosis

One of the most important adverse effects of a tumor necrosis factor (TNF)-alpha inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-alpha associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-alpha inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-alpha inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-alpha associated tuberculosis.

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Tuberculosis of the Spleen as a Cause of Fever of Unknown Origin and Splenomegaly

BACKGROUND/AIMS: Splenic involvement of tuberculosis, which is rare, warrants better definition in the current era of resurgence of tuberculosis. METHODS: Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients. RESULTS: All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV, and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes, cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period. CONCLUSIONS: In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement, and even in immunocompetent individuals.

A case of accessory splenic tuberculosis mimicking a distal pancreatic tumor / 대한내과학회지

Abdominal tuberculosis usually affects the gastrointestinal tract, peritoneum, lymph nodes, liver or spleen. Tuberculosis of the spleen is uncommon, except when associated with miliary dissemination. We report a case of a 33-year-old man with tuberculosis of the accessory spleen, which was originally suspected to be a distal pancreatic tumor. He was admitted with a history of left upper quadrant abdominal pain for 3 months. Computed tomography imaging of the abdomen revealed a 4.5 cm sized poorly defined hypodense mass in the distal pancreas and showed multiple focal hypodense lesions in the enlarged spleen. We performed distal pancreatectomy and splenectomy under the preoperative expectation of a distal pancreatic tumor. Microscopic examination of the specimens revealed accessory splenic tuberculosis associated with splenic tuberculosis. Following this, he was treated with appropriate antituberculosis drugs and was discharged without any complications.

Splenic tuberculosis: a report of three cases from Pham Ngoc Thach Hospital

Study on 3 cases of splenic tuberculosis with HIV(-), without pulmonary lesions, treated in Pham Ngoc Thach Hospital of Ho Chi Minh city. Among them, the first one might be a single splenic tuberculosis patient, because there was not any lesion in other areas; the second case was glandular tuberculosis combined with splenic tuberculosis; the third case perhaps was splenic tuberculosis combined with symptoms of tuberculous meningitis occurred 15 days after splenectomy. All 3 cases had major symptoms including mild fever and dull pain in left slope lasting from several months to a year. Ultrasound and abdominal computed tomography scan (CT-scan) showed numerous lesions in the spleen with <2cm size and unspecific decreased dark level with or without big spleen, however, dark increased area should be seen in ultrasound. 2/3 cases of splenectomy with pathological results was splenic tuberculosis, one case was not indicated surgery, making biopsy found a glandular tuberculosis. Splenic tuberculosis treatment with regime of anti-tuberculosis drug during 12 months was suitable