Isolated primary tuberculosis of spleen-A rare entity in the immuno-competent patient

Tuberculosis is a global public health concern, with 9.6 million affected individuals worldwide. Current screening and diagnostic regimes focus primarily on smear positivity, and hence, the rising numbers of Sputum negative and Extra-Pulmonary Tuberculosis has become a significant set-back to adequate diagnosis, disease notification and treatment, due to the large number of false negatives.

We hereby describe an intriguing presentation of tuberculosis - A 23 yr old lady with no comorbid illness, came to us with ten month history of on and off pyrexia, weakness and left hypochondriac pain. On evaluation, two isolated hypodense lesions in the spleen were detected. Diagnostic laparoscopy and Splenectomy were performed and histopathology revealed features of primary tubercular abscess.

Commonly, abdominal visceral involvement is seen as a part of miliary tuberculosis in the immuno-compromised patient. However, in the absence of any co-morbidity and preserved immune function, this case depicts the rare possibility of primary isolated Tubercular splenic abscess in the normal healthy individual.

We require a close eye and a keen sense of clinical acumen to accurately diagnose and treat smear negative and uncommon forms of Tuberculosis. Considering the growing prevalence and difficulty in disease control, there is need for greater knowledge and awareness to help mitigate the global burden of Tuberculosis.