Isolated spleen tuberculosis in an immunocompetent patient, a rare case report

Isolated splenic tuberculosis in an immunocompetent child: A case report

INTRODUCTION

Tuberculosis remains a major public health problem in developing countries. Isolated splenic tuberculosis is a rare form of extrapulmonary tuberculosis, with few cases documented in the literature, occurring mainly in immunocompromised individuals. The purpose of this article is to contribute to the medical knowledge regarding this rare disease and to highlight the diagnostic challenges and management approach.

CASE PRESENTATION

A 6-year-old immunocompetent child was admitted with febrile splenomegaly. Initial diagnostic evaluations, including imaging, suggested a possible diagnosis of lymphoma, prompting a laparoscopic splenectomy for diagnostic and therapeutic purposes. Histopathological examination of the splenic tissue revealed features consistent with tuberculosis, despite the absence of a detectable primary focus in the lungs or other organs. Postoperatively, the patient underwent a 6-month course of anti-tubercular therapy, with no recurrence observed during follow-up.

DISCUSSION

Isolated splenic tuberculosis is an uncommon entity, particularly in immunocompetent individuals. The diagnosis is often challenging and delayed due to its nonspecific presentation, which can often mimic other conditions such as lymphoproliferative disorders, metastatic diseases, or other granulomatous diseases. Definitive diagnosis is based on histopathological analysis.

CONCLUSION

Splenic tuberculosis, though rare in immunocompetent child, should be included in the differential diagnosis list of febrile splenomegaly, particularly in areas where tuberculosis is endemic. Early recognition and appropriate treatment are crucial to prevent complications and ensure favorable outcomes.

A Case of Isolated Splenic Tuberculosis Presenting as a Splenic Abscess Complicated by Rupture Leading to Splenectomy in an Immunocompetent Male

We report a rare case of splenic tuberculosis (TB) in a male patient with a competent immune system who had no previous record of pulmonary TB. A 56-year-old male patient came to our outpatient department complaining of upper abdominal pain with a few episodes of vomiting for three days. He had alcoholism, smoked for 15 years, and had no past history of diabetes mellitus, hypertension, TB, or HIV. An abdominal ultrasound and CT scan at admission showed pancreatitis with a splenic abscess. After five days of admission, the patient's vitals deteriorated, and he had severe abdominal pain. CT scan suggested a splenic abscess rupture with hemoperitoneum. An emergency exploratory laparotomy was performed, and a splenectomy was done due to the splenic abscess rupture. A cartridge-based nucleic acid amplification test from splenic intracapsular fluid detected a trace Mycobacterium tuberculosis complex. The patient was discharged after starting first-line antitubercular treatment for six months. After three months of follow-up, the patient was doing well with no complaints.

Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis

Background

The aim of this study was to characterize the contrast-enhanced ultrasound imaging features of focal splenic tuberculosis.

Material/Methods

We retrospectively analyzed the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging features of 22 patients with splenic TB confirmed by surgical histopathology or biopsy.

Results

Conventional US demonstrated that 15 of the 22 patients had a single lesion, while 7 had multiple lesions. The maximum diameter of the lesions ranged from 1.0 to 3.7 cm. Of the 22, 17 were detected with hypoecho and 5 were detected with complex echo by conventional US. Seven (7/22) were detected with blood flow signals by color Doppler flow image (CDFI). CUES demonstrated that 18 cases (81.8%, 18/22) began to enhance in the arterial phase, mostly followed by slow wash-out in the intermediate or late parenchymal phase, and 4 (18.2%, 4/22) presented with non-enhancement during all phases. The enhancement patterns were categorized into 4 types: Type I, homogeneous enhancement (2/22); Type II, rim-like enhancement (12/22); Type III, septation-like enhancement (4/22); and Type IV, non-enhancement (4/22).

Conclusions

CEUS showed that splenic TB lesions were enhanced in the arterial phase, followed by slow washed out or persistent enhancement in the intermediate and late parenchymal phases. The rim- or septation-like enhancement may be helpful for diagnosing splenic TB. The splenic lesions presenting round hypoecho by conventional US and complete non-enhancement by CEUS are highly suspicious of splenic TB.