Splenic tuberculosis presenting as ascites in immunocompetant patient

Area of Science:

• Gastroenterology
• Infectious Diseases
• Abdominal Imaging

Background:

• Tuberculosis (TB) commonly affects the lungs but can manifest in any part of the gastrointestinal tract, peritoneum, or pancreatobiliary system.
• Splenic tuberculosis is an exceptionally rare clinical presentation, particularly in individuals without compromised immune systems.
• Gastrointestinal TB often originates from a primary pulmonary infection, but extrapulmonary sites can be the initial presentation.

Observation:

• A 60-year-old immunocompetent male presented with ascites, a fluid accumulation in the abdomen.
• Diagnostic investigations revealed tuberculosis localized to the spleen.
• No evidence of active tuberculosis was found in the lungs or other organs, suggesting an extrapulmonary origin.

Findings:

• The case confirms splenic tuberculosis as an unusual manifestation of the disease.
• The absence of a primary infection focus challenges typical TB transmission pathways.
• Direct spread from adjacent organs, such as the spleen to the peritoneum, is a postulated mechanism for abdominal TB.

Implications:

• This case underscores the importance of considering extrapulmonary tuberculosis, including splenic involvement, even in immunocompetent patients.
• It expands the differential diagnosis for ascites and splenic lesions.
• Further research into the pathogenesis of splenic tuberculosis may elucidate alternative routes of infection and aid in earlier diagnosis and treatment.