Isolated spleen tuberculosis in an immunocompetent patient, a rare case report. (June 2021)

• Record Type: Journal Article
• Authors: Lestari, Diah Asih; Rahadiani, Nur; Syaiful, Ridho Ardhi
• Is Part Of: International journal of surgery case reports. Volume 83(2021)
• Publication Date: 2021-06
• Subjects: Case report -- Immunocompetent -- Infection -- Spleen -- Tuberculosis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105966
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Tuberculosis (TB), as a major public health concern, is affecting almost 10 million people globally. At present, diagnostic and screening efforts mainly focus on positive smear results. Therefore, the number of extra pulmonary and negative sputum TB is rising and hampering the diagnosis and treatment process due to the large number of false negatives. Rare cases such as solitary splenic TB are usually seen in patients with splenic abnormalities, spleen trauma, immunosuppression, sickle cell disease, pyogenic infections, etc. Presentation of case: A 40-year-old female with no comorbidity came with chief complaint of early satiety every mealtime and epigastric pain in the last 6 months prior to admission. There was no significant positive examination except for positive IGRA test and enlargement of spleen with multiple cystic lesions on abdominal CT. We performed laparotomy with splenectomy followed by a histopathology examination which showed features of primary tubercular abscess. Discussion: In the immunocompromised patient, the visceral abdomen is usually involved and a part of miliary TB. However, this case revealed the rare possibility of a healthy person with primary isolated tubercular splenic abscess while being immunocompetent and lacking any comorbidity. Conclusion: Splenic TB diagnosis is difficult in patients lacking pulmonary involvement and without specific symptoms. Thorough examinations and clinical expertise are needed to provide accurate diagnosis and treat uncommon forms of TB and cases with negative smear results in consideration of rising prevalence and difficult disease control. Highlights: A case of isolated splenic tuberculosis was found in an immunocompetent patient. In this case, TB is again the great imitator, with symptoms similar to malignancy. Conventional diagnosis is inconclusive, and only postsurgical pathology confirms TB. Anti-TB drugs are first line for splenic TB, with surgery for complicated cases. TB is a possible diagnosis for splenic mass, even in immunocompetent patients