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Splenic tuberculosis presenting as pyrexia of unknown origin
R Hamizah1, A G Rohana, S A Anwar
1Department of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur.
The Medical Journal of Malaysia
|August 9, 2007
Summary
This case study highlights isolated splenic tuberculosis (TB) in a previously healthy woman presenting with prolonged fever and enlarged spleen. Despite extensive treatment, the splenic lesion persisted, illustrating a rare clinical challenge.
Area of Science:
- Infectious Diseases
- Radiology
- Pathology
Background:
- Pyrexia of unknown origin (FUO) necessitates comprehensive investigation.
- Hepatosplenomegaly can be a sign of various systemic illnesses.
- Tuberculosis (TB) can manifest in atypical organs.
Observation:
- A previously healthy 38-year-old female presented with prolonged fever and hepatosplenomegaly.
- Investigations for FUO were negative, and CT scans revealed multiple splenic hypodense lesions unresponsive to antibiotics.
- Percutaneous splenic biopsy showed granuloma formation with Langhan's giant cells, indicative of TB.
Findings:
- The patient was diagnosed with isolated splenic tuberculosis.
- Treatment with anti-TB medication led to initial improvement but required an extended 24-month duration.
- Persistent splenic lesions on follow-up CT scans indicated incomplete resolution.
Implications:
- Isolated splenic TB is a rare clinical entity.
- Diagnosis can be challenging, requiring invasive procedures like biopsy.
- Treatment duration and monitoring strategies may need to be individualized for splenic TB.
- This case underscores the importance of considering TB in unexplained hepatosplenomegaly and splenic lesions.
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