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ISOLATED TUBERCULOSIS OF THE SPLEEN
Sanjeev Mani, Ravu Rananavare
Dept. of Radiology, BYL Nair Hospital, Mumbai 400 008.
We present a case of tuberculous involvement of the spleen seen as hypoechoic intra-splenic lesions on sonography and proved at autopsy.CASE REPORT
A 26 year old male presented with the chief complaints of low-grade fever and weight loss since 4 months. Chest radiograph revealed tuberculous infiltration in the left upper zone. Laboratory studies were normal. The patient was placed on anti-tuberculous chemotherapy; he however defaulted and did not follow-up.
Six months after his initial admission, the patient was re-admitted with high grade fever and abdominal pain. Clinical examination revealed an emaciated male with hepatosplenomegaly. Laboratory studies disclosed a haernoglobin of 9 gm% and a white cell count of 10,400 (neutrophils 65%, lymphocytes 35%). HIV status was negative (Elisa method). Chest radiograph showed left apical parenchymal infiltration with diffuse bilateral miliary disease. Abdominal sonography showed hepatomegaly with multiple echo poor lesions in the para-aortic region suggestive of abdominal lymphadenopathy. Multiple hypoechoic areas measuring between 3 mm and 5 mm were seen in the spleen. The patient was placed on anti-tuberculous chemotherapy but his condition continued to deteriorate and he expired, 6 days after admission. Autopsy revealed miliary dissemination in the lungs, liver, and spleen, and caseating intra-abdominal lymphadenopathy.
DISCUSSION
Abdominal tuberculosis usually affects the gastrointestinal tract, peritoneum, lymph nodes, liver or spleen. Tuberculosis of the liver or spleen is uncommon, except in association with miliary dissemination.[1]
Sonographically, multiple hypoechoic intraspicnic lesions have been reported in many conditions including tuberculosis, and myeloproliferative disorders including leukaemias, metastasis, lymphoma and Hodgkin's disease.[2] [3] A similar sonographic pattern has been reported in AIDS-related lymphomatous involvement of the spleen.[4] [5]
Accurate diagnosis of the aetiology is not always possible on sonography as the presence of abdominal lymphadenopathy and splenic lesions is also seen in AIDS-related lymphoma. Ultrasound guided fine needle aspiration biopsy allows a specific diagnosis to be made in most cases. [4]
REFERENCES
1 . Thoeni RF, Margulis AR. Gastrointestinal tuberculosis, Sent Roentgenol 1979; 14 : 283-94.
2. Mittelstaedt CA, Partain CL. Ultrasonic- pathologic classification of splenic abnormalities~ gray scale patterns. Radiology 1980; 134 : 697-702.
3. Kapoor R, Jain AK, Chaturvedi U Saba MM. Case report Ultrasound detection of tuberculomas of the spleen. Clin Ra&ol 199 1; 43 : 128-9.
4. Townsend RR, Laing FC, Jeffrey RB, Bottles K. Abdominal lymphoma in AIDS : evaluation with US, Radiology 1989; 171:719-24.
5. Nyberg DA, Jeffrey RB, Federle NIP, Bottles K, Abrams DL. AIDS-related lymphomas : evaluation by abdominal CT. Radiology 1986; 159 :59-63.
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