Chronic hepatosplenic abscesses in Brucellosis. Clinico-therapeutic features and molecular diagnostic approach

In order to analyze the clinical and therapeutic features of chronic hepatosplenic abscesses, and to define the diagnostic yield of new molecular techniques, we describe seven cases, four hepatic and three splenic, of this uncommon complication of Brucellosis. Onset of symptoms in all cases was insidious and the diagnostic delay considerable. Abdominal CT scan showed large, poorly defined lesions, with heterogeneous attenuation and thick central calcifications surrounded by hypointense areas. Histologically, all cases presented granulomas with central necrosis, a polymorphic infiltrate, few giant cells and peripheral fibrosis. The diagnostic yield with conventional microbiologic techniques was poor, whereas a Brucella PCR-assay of a tissue or pus sample was positive in all six cases in which it was performed. Conservative therapy with antibiotics, either alone or combined with percutaneous drainage, failed in all cases, so that in this type of lesion, the treatment of choice should be medical-surgical, in order to guarantee excision of the central calcium nucleus responsible for the persistence of the infection.