RESUMO
Tuberculosis(TB) is one of the most common infections affecting the population in the developing countries. With the rising human immunodeficiency(HIV) infection its incidence is on a rise even in the developed countries. Pulmonary TB is the commonest form of infection, However, multiple extrapulmonary sites have also been reported. The spleen is thought to be a rare organ involved in this infection. Various presentations of the splenic TB have been reported in the literature. The definitive diagnosis of this is essentially formulated on the post-splenectomy specimen. A consensus statement based on the available case reports is lacking. The authors are providing an insight into this form of extrapulmonary TB after reviewing the available literature.
Assuntos
Tuberculose Esplênica/diagnóstico , Tuberculose Esplênica/fisiopatologia , Países em Desenvolvimento , Humanos , Incidência , Tuberculose Esplênica/epidemiologia , Tuberculose Esplênica/terapiaRESUMO
We report a case of a previously healthy 38-year old lady who presented with prolonged fever and hepatosplenomegaly. Intensive investigations were performed for pyrexia of unknown origin which revealed negative. CT scan of the abdomen showed multiple hypodense lesions which did not respond to broad-spectrum antibiotics. Percutaneous biopsy of the splenic lesion revealed granuloma formation and Langhan's giant cells suggestive of TB. She responded well with anti- TB medication but required extended treatment duration of 24 months due to persistence of the splenic lesion on repeated CT scans. This case illustrates a very rare clinical entity of isolated splenic TB with a therapeutic dilemma following incomplete resolution, despite prolonged treatment.
Assuntos
Febre de Causa Desconhecida/etiologia , Tuberculose Esplênica/fisiopatologia , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Malásia , Tomografia Computadorizada por Raios X , Tuberculose Esplênica/tratamento farmacológicoRESUMO
LEARNING OBJECTIVES: Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis.
Assuntos
Peritonite Tuberculosa/diagnóstico por imagem , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Esplênica/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Peritonite Tuberculosa/fisiopatologia , Tuberculose Gastrointestinal/fisiopatologia , Tuberculose Hepática/fisiopatologia , Tuberculose dos Linfonodos/fisiopatologia , Tuberculose Esplênica/fisiopatologia , UltrassonografiaRESUMO
Splenic tuberculosis is uncommon. We report here splenic tuberculosis in 5 patients with fever of over 3 weeks duration. In the 5 patients, abdominal ultrasonography and/or abdominal computed tomography revealed multiple hypoechoic and hypodense splenic lesions. 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 2 of these patients worsened and splenectomy was done. Histological examination of a tissue specimen of the spleen showed multiple caseating granulomas.