Indolent fever, weight loss and spleen infiltrate

This is a case of a young female who was admitted to our department with fever of one month in duration, without a specific pattern, anemia, lymphadenopathy and weight loss. The initial clinical and radiological evaluation and laboratory tests, although extensive, were unrevealing. The patient's general situation was temporarily improved and she was dismissed, but she revisited our hospital 2, 5 months later because of fever recurrence and a new pain at the upper left abdomen. This time the pathological findings were more prominent. The abdomen CT scan revealed a splenic mass. The evidence was suggestive of lymphoma, granulomatous or unusual infectious disease. However, it was not possible to establish a certain diagnosis, so we proceeded to open splenectomy and histological analysis that disclosed an inflammatory pseudotumor of the spleen. This procedure apart from diagnostic proved to be also therapeutic. The patient was cured and at six-month follow up she was in perfect health. Our case suggests that a high index of suspicion regarding this entity is needed, particularly if the disease course is variable and protracted.