Splenic abscess as a rare symptom of the extrapulmonary tuberculosis – case report

Download PDF Česká verzia

Authors: P. Horák ¹; B. Horová ²; H. Koutníková ³; J. Marvan ¹; J. Fulík ¹; J. Fanta ¹
Authors place of work: Chirurgická klinika 1. lékařské fakulty Univerzity Karlovy a Nemocnice Na Bulovce, Praha ¹; Oddělení klinické mikrobiologie Nemocnice Na Bulovce, Praha ²; Patologicko-anatomické oddělení Nemocnice Na Bulovce, Praha ³
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 7, s. 297-300.
Category: Case Report

Summary

Introduction: Extrapulmonary tuberculosis can involve any organ or tissue. It is a rare disease in the Czech Republic with an incidence rate of 0.62 cases per 100.000 persons. It affects mostly immunocompromised patients. The most common sites include lymph nodes, the urogenital system, skin, joints, bones and serous epithelium – the peritoneum, pleura, and pericardium. Splenic involvement is rare. Mycobacterium is a slow growing intracellular parasite. The diagnostic process is very difficult; microbiological diagnosis is critical.

Case report: An 84 years old female patient with subcapsular splenic rupture with no trauma history as a cause of anemia. Splenic abscess was diagnosed during surgical revision and splenectomy. Tuberculosis was suspected based on subsequent histological analysis, which was confirmed after nine weeks of peritoneal fluid culture. The surgical procedure and postoperative hospitalization were not associated with any complications. The patient was referred to the respiratory clinic for further treatment.

Conclusion: The diagnosis of extrapulmonary tuberculosis including splenic localization should always be considered. A sample from the affected tissue or effusion must be collected in the case of unclear perioperative findings and sent for complete bacteriological testing, including mycobacterial culture. If a tuberculous splenic abscess is found, the therapeutic process should involve its complete drainage in combination with long-term anti-TB medication.

Keywords:

splenic tuberculosis – abscess – splenectomy

Zdroje

https://www.uzis.cz/publikace/zakladni-prehled-epidemiologicke-situace-ve-vyskytu-tuberkulozy-v-cr-v-roce-2017
Kolek V, Kašák V, Koblížek V, et al. Pneumologie. In: Češka R a kol. Interna. 1. vyd. Praha, Triton 2010:483.
Zatloukal P, Kos P, Vašáková M. Tuberkulóza dospělých (Standard léčebného plánu). Aktualizace 2016:7. Available from: www.pneumologie.cz/guidelines.
Raviraj S, Gogia A, Kakar A, et al. Isolated splenic tuberculosis without any radiological focal lesion. Case Rep Med. 2015;130209. doi:10.4103/0971-9784.142068.
Kumar V, Pandey D. Isolated hepatosplenic tuberculosis. Hepatobiliary Pancreat Dis Int. 2008;7:328−30.
Chakradhar K, Prasad S, Kumar S, et al. A rare presentation of splenic tuberculosis with a pseudocyst. BMJ 2014 Published online. doi: 10.1136/bcr-2014-203596.
Jain D, Verma K, Jain P. Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses. Oxf Med Case Reports 2014:107−9. doi: 10.1093/omcr/omu042.
Raul SK, Tiwari S, Raina V, et al. Tubercular splenic abscess in immunocompetent patients: a rare entity. Indian J Surg. 2009;71:213−5.
Divyashree S, Gupta N. Splenic abscess in immunocompetent patients managed primarily without splenectomy: A series of 7 cases. Perm J. 2017;21:16−139. doi: 10.7812/TPP/16-139.
Jain SK, Kaza RC, Vindal A. Pseudocyst of the spleen caused by tuberculosis: a rare entity. BMJ Case Rep. 2009. Published online. doi: 10.1136/bcr.06.2008.0102.
Zhang Y, Zhang J, Chen T, et al. Spontaneous splenic rupture in an acute leukemia patient with splenic tuberculosis: A case report. Mol Clin Oncol. 2017;6:209−13. doi:10.3892/mco.2016.1120.
Hasan M, Sarwar J, Bhuiyan J, et al. Tubercular splenic abscess. Mymensingh Med J. 2008;17:67−9.
Lee KJ, Yoo JS, Jeon H, et al. A case of splenic tuberculosis forming a gastro-splenic fistula. Korean J Gastroenterol. 2015;66:168−71. doi: 10.4166/kjg.2015.66.3.168.
Lonkar Y, Parikh S, Kumar S, et al. Splenic tuberculosis presenting as ascites in immunocompetant patient. Ann Med Health Sci Res. 2013;3:116-8. doi: 10.4103/2141-9248.109473.
Dal MS, Dal T, Tekin R, et al. Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report. Infez Med. 2013;21:50−5.
Kim HH, Park SJ, Park MI, et al. 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. doi: 10.4021/jocmr800w.
Cheung WI, Leung VK, Luk IS, et al. Splenic tuberculosis associated with monoclonal gammopathy of undetermined significance and pericarditis. Hong Kong Med J. 2009;15:291−3.
Prieto-Nieto MI, Pérez-Robledo JP, Díaz-San Andrés B, et al. Inflammatory pseudotumour of the spleen associated with splenic tuberculosis. World J Gastrointest Surg. 2014;6:248−52. doi: 10.4240/wjgs.v6.i12.248.
Khadka M, Pradhan R. Isolated splenic cold abscesses with perisplenic extension: Treated successfully without splenectomy. Case Rep Gastrointest Med. 2017;9864543. doi: 10.1155/2017/9864543.
Kumar A, Kapoor VK, Behari A, et al. Splenic tuberculosis in an immunocompetent patient can be managed conservatively: a case report. Gastroenterol Rep. (Oxf). 2018;6:72−4. doi: 10.1093/gastro/gov058.
Imani Fooladi AA, Hosseini MJ, Azizi T. Splenic tuberculosis: a case report. Int J Infect Dis. 2009;13:e273−5. doi: 10.1016/j.ijid.2008.11.002.
Gupta A, Hunjan PS, Jain SK, et al. Tubercular splenic abscess in an immunocompetent patient-a rare entity. Southeast Asian J Trop Med Public Health 2006;37:1196−8.