Splenic tuberculosis in a patient with ankylosing spondylitis treated with adalimumab.

We present a rare case of splenic tuberculosis in a 42-year old man with long-standing ankylosing spondylitis treated with adalimumab. We review the association between antitumor necrosis factor therapy and splenic tuberculosis. Our case, like many other reported cases, illustrates that the index of suspicion of tuberculosis in patients treated with anti TNF therapies must be high and emphasizes that this rare infection may occur even with negative tuberculosis screening before the initiation of therapy.

MRI features of focal splenic lesions in patients with disseminated tuberculosis.

OBJECTIVE: The aim of this study is to describe the MRI features of focal splenic lesions in patients with disseminated tuberculosis. CONCLUSION: Tuberculous focal splenic lesions are small, multiple, and most often associated with splenomegaly. Signal intensities vary on both T1- and T2-weighted images. Two different enhancement patterns are noted: peripheral enhancement and gradual peripheral enhancement with complete fill-in.

[Disseminated tuberculosis in non-immunocompromised host: three case reports]. / Tuberculose disséminée sur terrain non immunodéprimé: à propos de trois cas.

INTRODUCTION: Disseminated tuberculosis, i.e., tuberculosis involving lung, liver, spleen, bone marrow and lymph nodes is rare (2.8%), particularly when immunocompromised diathesis is lacking. EXEGESIS: We report three cases of disseminated tuberculosis confirmed by bacteriology or histology, which occurred in non-immunocompromised patients. Disease evolution under antituberculous treatment was favorable in two cases and fatal in the third one. CONCLUSION: Disseminated tuberculosis must be suspected when miliary pulmonary lesions are associated with hematologic abnormalities, even in non-immunocompromised host. Early treatment is mandatory to avoid fatal outcome.

Clinical significance of splenic tuberculosis in patients infected with human immunodeficiency virus.

To assess the clinical significance of splenic tuberculosis in patients infected with human immunodeficiency virus (HIV) type 1, we compared 20 patients who had splenic tuberculosis with 20 randomly selected, HIV-infected patients with culture-proven tuberculosis for whom splenic involvement had been ruled out by ultrasonography. All of the patients were male prison inmates and intravenous drug users. Statistically significant differences (P < .05) were detected between patients with splenic involvement (median CD4+ cell count, 54/mm3) and those without splenic involvement (median CD4+ cell count, 92/mm3). No specific symptoms suggesting splenic involvement were detected in the patients with splenic tuberculosis. All patients received antituberculous drugs, and none of these patients required splenectomy. The median survival was similar in both groups. Splenic tuberculosis occurs in more-severely immunocompromised HIV-infected patients, the prognosis is generally good, the clinical response to therapy is usually favorable, and splenectomy is rarely necessary.

[Disseminated extrapulmonary tuberculosis in idiopathic CD4-lymphocytopenia]. / Disseminierte extrapulmonale Tuberkulose bei idiopathischer CD4-Lymphozytopenie.

A previously healthy, now 42-year-old man suddenly fell ill with bouts of septic fever up to 39.5 degrees C, sweats and weight loss without any demonstrable organ involvement. Physical examination on hospitalization 3 weeks after onset of the illness was unremarkable. Blood sedimentation rate at one hour was 123 mm. There was also a moderate increase in gamma-GT and alkaline phosphatase. Routine bacteriological and serological tests failed to discover a causative microorganism. After imaging tests had provided first indication of splenic and hepatic involvement, biopsies of these two organs demonstrated disseminated epithelioid granulomas and Langhans giant cells. Staining and culturing of pelvic crest biopsy tissue showed evidence of Mycobacterium tuberculosis, but there was no evidence of pulmonary involvement. In addition to four-drug tuberculostatic treatment the patient was given glucocorticoids for several weeks to control the fever bouts. Persistent CD4+ T-lymphocytopenia was demonstrated as the cause of the entirely extrapulmonary tuberculosis in this HIV-negative patient. This is an only recently described and so far unexplained syndrome.

Acute hypersplenism and thrombocytopenia: a new presentation of disseminated mycobacterial infection in patients with acquired immunodeficiency syndrome.

We describe 2 patients with acquired immunodeficiency syndrome who presented with acute or subacute splenomegaly and thrombocytopenia secondary to disseminated Mycobacterium avium complex (MAC). The patients were treated for immune thrombocytopenic purpura without success. Thrombocytopenia may be a prominent feature of MAC. Our experience suggests that disseminated MAC may present with acute splenomegaly and thrombocytopenia in these patients and that a high index of suspicion for disseminated tuberculosis is indispensable in order to avoid delay in diagnosis and treatment in patients presenting with rapidly progressive splenomegaly and thrombocytopenia.

[Abdominal tuberculosis in patients with acquired immunodeficiency syndrome]. / Tuberculosis abdominal en los pacientes con síndrome de inmunodeficiencia adquirida.

BACKGROUND: In individuals with HIV infection, extrapulmonary forms of tuberculosis are considered as opportunistic infections and are included in the diagnosis of AIDS. They often have atypical clinical features. Abdominal participation is uncommon and its diagnosis may be difficult. METHODS: The clinical, radiological and pathological features of patients with a diagnosis of AIDS with abdominal tuberculosis in a series of 254 AIDS cases in a general hospital from 1984 to October 1990 were reviewed. RESULTS: Tuberculosis developed in 104 (41%) of AIDS patients. In 25 (24%) the disease was exclusively pleuropulmonary and in 79 (76%) extrapulmonary tuberculosis was present, either alone or in association. Extrapulmonary tuberculosis was the first opportunistic infection in 66 AIDS cases (26%). The abdominal participation was demonstrated in 19 patients, with the following localizations: lymph nodes (9), liver (8), spleen (5), ileum (1) and peritoneum (1). Four patients with splenic tuberculosis also had multifocal nodular lesions. CONCLUSIONS: Abdominal participation was found in 19 of the 104 AIDS patients with tuberculosis (18%). Lymph node involvement was the most common type. Hepatosplenic tuberculosis had a miliary form or showed multifocal images in echography or computed tomography.

Spleno-hepatic tuberculosis due to Mycobacterium kansasii.

A case of tuberculosis of the spleen and liver is described. The organism involved was Mycobacterium kansasii, one of the atypical mycobacteria. The lack of evidence in the literature of primary splenic or hepatic involvement by this organism suggests that it is rare. In this instance it complicated a case of myeloproliferative disease, megakaryocytic myelosis with extra-medullary haemopoiesis, and was not diagnosed until autopsy.

Distribution of mycobacteria grown in vivo in the organs of intravenously infected mice.

Suspensions of 35-day-old Mycobacterium tuberculosis H37Rv prepared from stirred liquid cultures and injected intravenously into CD-1 mice accumulated in the lungs at a significantly higher concentration that that seen with logarithmically growing cells. Mice were infected with logarithmic 8-day-old or stationary phase 35-day-old suspensions of H37Rv, and 24 hours later, the bacilli within pooled lung and splenic homogenates were recovered by differential centrifugation. The bacilli were then homogenized in Tween saline and injected intravenously into fresh mice. The partitioning of the 4 inocula into the lungs and spleens of the secondary recipients was compared to that for the original suspensions grown in vitro. There was a significant increase in the number of lung-adapted H37Rv that could again be recovered from the lungs of the secondary recipients compared to that observed for the corresponding splenic preparations. This effect was not due to bacterial clumping or to size differences in the organisms grown in vivo. Homogenation of H37Rv with normal lung increased the relative accumulation of viable bacilli in the lungs compared to the spleens of recipient mice.