A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula / 대한소화기학회지

We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.

Tuberculosis of the spleen: a case report.

A 40-year old Thai male presented with epigastric discomfort and weight loss without fever for 2 months. On examination, there was no hepatosplenomegaly or lymphadenopathy. His ultrasonogram showed multiple lesions in the spleen with enlarged abdominal lymph nodes. Pathology revealed caseating granulomas of the spleen and lymph nodes. No AFB were seen but PCR was positive for M. tuberculosis complex. The fever resolved within 3 days of surgery and the patient was treated with antituberculous drugs.

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.

Micobacteriosis hepato-esplénica, forma inusual de probable tuberculosis extrapulmonar: Caso clínico y revisión bibliográfica / Hepatic-splenic micobacteriosis, unusual form of probable extrapulmonary tuberculosis: Case report and review

Reportamos el caso de un hombre de 42 años, seronegativo para VIH, con fiebre de origen desconocido (FOD), asociada a elevación de transaminasas y fosfatasas alcalinas con patrón colestásico e imágenes hepáticas hipodensas en la tomografía axial computada. La biopsia hepática demostró la presencia de granulomas tuberculosos con visualización de un bacilo con alcohol-ácido resistencia. El cuadro respondió al tratamiento con fármacos antituberculosos presentando caída de curva febril, mejoría del estado general y normalización de parámetros de laboratorio.

We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.

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.

Tuberculous splenic abscess--a case report and review of literature.

Splenic abscess due to tuberculosis is a rare condition and is mostly diagnosed in immuno-compromised hosts. A case of tuberculous splenic abscess detected incidentally after splenectomy without any underlying disease is reported in an immuno-competent patient.

Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient

We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm³), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.

Co-existence of spontaneous splenic rupture and tuberculosis of the spleen

A rare case of splenic tuberculosis complicated by splenic rupture is reported. A 73-year-old man, hospitalized for peptic ulcer bleeding, presented in oligemic shock, was transferred to the operating room. Hemoperitoneum, due to rupture of an enlarged spleen was detected. The pathology revealed splenic tuberculosis. He had an uneventful recovery. Postoperatively, he received a combination of anti-tuberculous therapy for 6 months

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).

Abscessos esplênicos por mycobacterium tuberculosis em paciente com AIDS / Splenic abscesses due to mycobacterium tuberculosis in patient with AIDS

Trata-se do caso de paciente com AIDS há 11 anos, que desenvolveu púrpura trombocitopênica trombótica (PTT) e febre prolongada. A ultra-sonografia e a tomografia computadorizada de abdômen sugeriam múltiplos abscessos esplênicos, diagnosticando-se tuberculose abdominal por meio de biópsias esplênica, hepática e peritoneal, por videolaparoscopia. Houve evolução favorável com o tratamento da tuberculose.

A 39-year-old woman infected with HIV eleven years ago was admitted with thrombotic thrombocytopenic purpura and intermitent fever. Abdominal ultrasonography and CT scan showed multiple lesions in the spleen, a finding consistent with abscesses. The videolaparoscopy revealed lesions suggestive of abdominal tuberculosis, confirmed by spleen, liver, and peritoneum biopsies. The patient's condition improved with antituberculous therapy.

Tuberculous abscess of the abdominal wall and multiple splenic abscesses in an immunocompetent patient.

We report a case of a 39-year-old human immunodeficiency virus (HIV)--negative male who presented with a progressively increasing swelling in the left hypochondrium. He did not manifest fever or toxaemic symptoms. Computerised tomographic scan (CT scan) of the abdomen revealed an abscess in the anterior wall and multiple splenic abscesses. Fine needle aspiration from the abscesses in the anterior abdominal wall and the spleen confirmed the diagnosis of tuberculosis as the aetiology. The patient responded well to antituberculosis treatment and the abscesses regressed considerably.

Isolated tubercular splenic abscess.

Splenic abscess due to tuberculosis is extremely rare in immunocompetent individuals. We report a case of tubercular splenic abscess (TSA) in an immunocompetent individual for its rarity.

Tubercular splenic abscesses in a patient with AIDS.

Opportunistic infections are common in patients with AIDS. There is an increasing incidence of tuberculosis, especially extrapulmonary tuberculosis. Splenic abscesses is one such, though rare, extrapulmonary manifestation. We report such a case discuss the diagnosis and treatment in these cases.

La ultrasonografía abdominal como método diagnóstico orientador en tuberculosis y/o micobacteriosis en pacientes H.I.V. / Abdominal tuberculosis in patients with AIDS: U.S. findings

Los pacientes HIV con tuberculosis y/o micobacteriosis se presentan en muchas oportunidades solamente como un síndrome febril. Nuestro objetivo fue evaluar la utilidad de la ultrasonografía abdominal en el diagnóstico de la patología micobacteriana asociada a la infección HIV. Se estudiaron 77 pacientes febriles con aislamiento previo o posterior al estudio de micobacterias (M. Tuberculosis: 74; atípicas: 3). Se utilizó equipo General Electric RT 4000, Transductor 3.5 MHz. Sectorial y lineal. Se realizó ecografía abdominal. Se realizó punción esplénica dirigida (2), punción hepática dirigida (12), punción psoas (1). Resultados: adenopatías retroperitoneales en 49 (64 por ciento); lesiones focales hipoecoicas (5-12 mm) en bazo 29 (38 por ciento), se punzaron 2 BAAR + Patrón hiperecogénico hepático en 39 (50,6 por ciento); lesiones focales hipoecoicas hepáticas en 2, se punzó 1 (Caseum); absceso hepático por M. Tuberculosis (1); acsitis en 21 (27 por ciento); absceso bilateral del psoas 2, se punzó 1 (BAAR +); trombosis vena esplénica 2; sin hallazgos ecográficos 10 (13 por ciento). El estudio demostró que las infecciones por micobacterias se pueden sospechar fuertemente ante un síndrome febril y presencia de adenopatías retroperitoneales (64 por ciento) y/o lesiones focales hipoecoicas de bazo (38 por ciento). Otros hallazgos como el patrón hiperecogénico se observó en un 57 por ciento. Se encontró una baja incidencia de lesiones focales hepáticas. La ecografía abdominal orienta en un 87 por ciento de los casos hacia el compromiso abdominal por micobacterias