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

Isolated splenic tuberculosis.

The authors report two cases of isolated splenic tuberculosis treated since 1989 in Nizam's Institute of Medical Sciences. One case presented as pyrexia of unknown origin (PUO) and another with idiopathic thrombocytopenic purpura (ITP). Both were found to have splenic tuberculosis after splenectomy. Pre operative diagnosis could not be made in these cases. Splenectomy followed by antituberculous chemotherapy cured the condition in both the cases. The authors underline the diagnostic difficulties, essentially related to the rarity of this condition inspite of the progress in modern imaging.

Splenic tuberculosis in patients with fever of unknown origin

In this study, splenic tuberculosis was reported in five patients with fever of over three weeks duration. In those patients, abdominal ultrasonography and/or abdominal computed tomography revealed multiple hypoechoic and hypodense splenic lesions. The diagnosis required biopsy of cervical lymph nodes in four cases and splenectomy in one. Despite vigorous antituberculous therapy with isoniazid, rifampin and ethambutol; the clinical condition of two of these patients worsened and splenectomy was done. Histological examination of a tissue specimen of the spleen showed multiple caseating granulomas