Splenic tuberculosis presenting as ascites in immunocompetant patient

Solitary Splenic Tuberculosis in an Immunocompetent Child: A Case Report

Tuberculosis (TB) is a lethal infectious disease that still remains a major threat in developing countries. Solitary splenic tuberculosis is a rare entity and there have been very few cases of it reported in literature. It is mostly encountered in patients who have an immunocompromised state. It may occur with a myriad of non-specific presentations, making it complex to diagnose. Here, we report a case of an eight-year-old female, immunocompetent, who had complaints of fever, abdominal pain and chronic diarrhea. Laboratory data failed to provide any information about the final diagnosis. On physical examination, splenomegaly was present. Imaging studies were conducted with an abdominal ultrasound showcasing mild ascites, splenomegaly, with a homogeneous echo pattern and no focal mass. Computed tomography (CT) of the abdomen showed two hypodense areas in the subcapsular region of the spleen and extending into the capsule, suggestive of a tuberculous abscess with mesenteric lymphadenopathy. The diagnosis was further corroborated when the patient showed remarkable improvement on anti-tuberculous therapy. This is a very uncommon phenomenon, especially in an immunocompetent patient and hence, it is very important to keep this on the list of differentials especially in an area where TB is endemic.

Unusual location of tuberculosis in the course of tumor necrosis factor α inhibitor therapy

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis complex mycobacteria. Extrapulmonary tuberculosis usually develops more than two years after infection or many years later. Factors favoring onset of the disease are malnutrition, older age, renal failure, diabetes, cancer, immunosuppression and biological treatment, e.g. tumor necrosis factor α (TNF-α) inhibitors. The paper presents a case of a 56-year-old patient with ankylosing spondylitis treated with infliximab, diagnosed with tuberculosis of the spleen. The unusual location and uncharacteristic symptoms created a lot of diagnostic difficulties, particularly as during qualification for biological treatment tests are performed to exclude infection with Mycobacterium tuberculosis. Pharmacological treatment of tuberculosis is typical, but in the case of tuberculosis of the spleen, splenectomy also is a method of treatment. The decision was made to implement pharmacological treatment, which proved to be effective, so the patient avoided surgery.