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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 5
| Issue : 2 | Page : 102-103 |
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Tuberculous splenic abscess in a nonhuman immunodeficiency virus patient
Abhishek Juneja1, Rajat Jhamb2
1 Department of Neurology, Dr RML Hospital, Delhi, India
2 Department of Medicine, UCMS and GTB Hospital, Delhi, India
| Date of Submission | 30-Apr-2020 |
| Date of Acceptance | 08-Jun-2021 |
| Date of Web Publication | 23-Jul-2021 |
Correspondence Address:
Dr. Abhishek Juneja
A-15, Old Quarter, Back Side, Ramesh Nagar, Delhi - 110 015
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/LJMS.LJMS_36_20
How to cite this article:
Juneja A, Jhamb R. Tuberculous splenic abscess in a nonhuman immunodeficiency virus patient. Libyan J Med Sci 2021;5:102-3 |
Dear Editor,
We report the case of a 22-year-old female patient with poorly localized mild abdominal pain and anorexia for 6 weeks and fever for 4 weeks. Fever was continuous, low grade with evening rise of body temperature. There was no past medical history of any chronic illness. On examination, she had mild pallor and upper abdominal tenderness to palpation with mild hepatosplenomegaly. Her routine investigations showed a hemoglobin level of 9.8 mg/dl, erythrocyte sedimentation rate of 46 mm/h, and serum albumin of 2.8 g/dl. Other routine biochemical investigations were normal. Human immunodeficiency virus (HIV) test by enzyme-linked immunosorbent assay was negative. Her CD4 count was 846/mm3. Chest radiograph was normal. Ultrasound abdomen was suggestive of multiple hepatic and splenic hypoechoic collections with minimal ascites. A contrast-enhanced abdominopelvic computerized tomography (CT) scan revealed multiple ill-defined hypodense lesions in the liver and spleen likely granulomas, along with multiple small hypodense lesions in the spleen at subcapsular location likely abscess with hepatosplenomegaly [Figure 1]. Ultrasongraphy (USG)-guided needle aspiration of splenic lesion revealed frank pus which was subjected to further testing. Mycobacterium tuberculosis (MTB) bacteria were stained positive with associated granulomas. The patient was started on antitubercular therapy and followed up over the next 6 months. The patient gradually improved and regained her appetite and fever subsided. Serial USG scans of the abdomen showed a decreasing size of hypoechoic lesions. | Figure 1: Contrast-enhanced computerized tomography abdomen showing multiple hypodense lesions with hepatosplenomegaly
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Splenic abscess is a rare but life-threatening condition with an incidence between 0.14% and 0.7%.[1],[2] Tuberculous splenic abscess is a form of atypical extrapulmonary tuberculosis (TB). It is a rare clinical condition, usually found in immunocompromised individuals including HIV infection.[3] It is rarer in immunocompetent individuals.[4] Splenic abscess generally occurs as a part of disseminated TB or rarely as an isolated form. Imaging modalities including ultrasonogram and computed tomogram are required to diagnose such cases. Definite diagnosis can only be made on histopathology requiring invasive diagnostic modalities.[5] Tuberculous abscesses typically are round/oval, hypodense lesions on CT scans. These findings are nonspecific mimicking multiple other conditions such as hydatid cyst, metastases, and lymphoma. We established the diagnosis by aspirating pus using USG-guided technique. MTB bacteria were stained positive with Ziehl–Neelsen stain. The patient was started on antitubercular therapy and gradually improved. Clinicians should keep in mind that splenic and hepatic abscesses can occur in immunocompetent individuals. Definite diagnosis should be established based on histopathology. Early diagnosis and prompt effective treatment can prevent fatal complications.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, et al. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006;12:460-4.  |
| 2. | Westh H, Reines E, Skibsted L. Splenic abscesses: A review of 20 cases. Scand J Infect Dis 1990;22:569-73. |
| 3. | Kim HH, Park SJ, Park MI, Moon W. Primary tuberculous abscess of the spleen in an immununocompetent patient diagnosed by biochemical markers and radiologic findings. J Clin Med Res 2012;4:149-51. |
| 4. | Agarwala S, Bhatnagar V, Mitra DK, Gupta AK, Berry M. Primary tubercular abscess of the spleen. J Pediatr Surg 1992;27:1580-1. |
| 5. | Sharma SK, Smith-Rohrberg D, Tahir M, Mohan A, Seith A. Radiological manifestations of splenic tuberculosis: A 23-patient case series from India. Indian J Med Res 2007;125:669-78. [ PUBMED] [Full text] |
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