Splenic tuberculosis presenting as hypersplenism

Multidrug-resistant tuberculosis presenting as a solitary splenic mass in an immunocompetent patient

Here, we report a case of multidrug-resistant tuberculosis (TB) presenting as a solitary splenic mass in a 60-year-old immunocompetent patient. Splenic TB is unusual and, when present, is usually associated with disseminated disease in immunocompromised patients. A high level of suspicion is required for diagnosis, and, as occurred in our case, it may be an unexpected finding following surgery. Diagnosis was made by polymerase chain reaction, which showed the presence of Mycobacterium tuberculosis DNA. Interestingly, rifampicin- and isoniazid-resistant genes were detected in our analysis. Splenic TB diagnosis and treatment are reviewed.

Tuberculosis of the spleen as a cause of Fever of unknown origin and splenomegaly

BACKGROUND/AIMS

Splenic involvement of tuberculosis, which is rare, warrants better definition in the current era of resurgence of tuberculosis.

METHODS

Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients.

RESULTS

All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV, and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes, cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period.

CONCLUSIONS

In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement, and even in immunocompetent individuals.

[Isolated pseudo-tumoral tuberculosis of the spleen. A case report]

INTRODUCTION

The tuberculosis isolated tumoral spleen is rare, even in the countries to strong tubercular endemic.

EXEGESIS

From an observation, concerning an important, tumoral and isolated splenomegaly in 48-year-old-man. The authors put the accent on his tumorous variety by the clinic, the imagery and on macroscopic appearance of the operative piece. Are discussed the isolated character, the way of dissemination, the site of initial infestation and the deceitful character of haematological manifestations. A splenectomy to diagnostic and therapeutic goal have been realised, associated to the chemotherapy.

CONCLUSION

This is an expression of the profound organ's tuberculosis rich on endothelial reticular system. It's mean a singular topography of the bacillary lesion and a great distribution of the tubercular affect.

Isolated splenic tuberculosis

Tuberculosis isolated to the spleen is a rare clinical entity particularly in the non-HIV-positive patient population. In the four patients described, two presented with thrombocytopenia; in two patients the condition was diagnosed serendipitously at laparotomy undertaken for abdominal trauma.

[Splenomegaly and splenic pseudotumor due to tuberculosis: six new cases]

INTRODUCTION

Splenic tuberculosis is rare. The aim of this study was to remind diagnostic problems in this disease, and to evaluate the value of surgery in its management.

MATERIAL AND METHODS

Retrospective study of data of six patients (three male and three female, whose mean age was 50 years) admitted in surgical department from 1980 to 2000 for splenic tuberculosis.

RESULTS

In six cases, symptoms were poorly specific; splenomegaly and anemia were constant. In imaging studies, splenomegaly was homogeneous in four cases and heterogeneous in two. Diagnosis of tuberculosis was done without need for splenectomy in four patients. Five patients were operated on: two had diagnostic laparotomy without splenectomy, two underwent diagnostic splenectomy and one had splenectomy indicated for splenic abcess refractory to medical treatment. Four of the five operated patients recovered. The two other patients were lost of follow-up.

CONCLUSIONS

In our experience, surgery is useful in diagnosis and treatment of splenic tuberculosis.

Clinical application of serial operations with preserving spleen

AIM: To evaluate the clinical application of serial operations with preservation of spleen.

METHODS: Serial operations with preserving spleen were performed on 211 cases in our hospital from 1980 to 2000. The patient’s age ranged from 13 to 56 years, averaging 38 years. Diseases included splenic injury in 171 cases, portal hypertension in 9 cases, splenic cyst in 10 cases, and the lesion of pancreatic body and tail in 21 cases.

RESULTS: All the cases were cured, and 129 patients were followe dup from 3 mo to 3 years with the leukocyte phagocytosis test, detection of immunoglubin, CT, ^99mTc scanning and ultrasonography. The results were satisfactory.

CONCLUSION: The operations with preserving spleen were safe, feasible, and worth of clinical application.