Isolated Splenic Tuberculosis without Any Radiological Focal Lesion

Incidence of tuberculosis (TB) of spleen is a rare entity and isolated splenic tuberculosis is an unusual phenomenon, especially in immunocompetent individuals. We came across a case of 63-year-old male who presented with high grade fever, loss of weight, and generalized weakness of one-month duration. When physically examined, he had pallor and moderate nontender splenomegaly without any other significant clinical findings. He had pancytopenia, elevated ESR, and positive Mantoux test. Ultrasonography and CT scan of abdomen showed splenomegaly without any other relevant findings. Markers of connective tissue disorders and bone marrow aspiration and biopsy all were noncontributory for diagnosis. Hence splenic biopsy was done and sent for histopathological examination. Presence of caseation surrounded by epitheloid granulomas and Langerhans cells was suggestive of diagnosis as tuberculosis. And gene probe for the AFB (acid fast bacilli) came to be positive. No primary focus was present in either lungs or other organs. Patient improved clinically with antitubercular treatment.