Isolated splenic tuberculosis with subsequent paradoxical deterioration: a case report

Area of Science:

• Infectious Diseases
• Microbiology
• Immunology

Background:

• Tuberculosis (TB) of the spleen is uncommon, typically affecting immunosuppressed individuals.
• Splenic Mycobacterium tuberculosis infections present diagnostic challenges due to pathogen sequestration.
• This report focuses on a unique case of isolated splenic TB in an immunocompetent patient.

Observation:

• A 26-year-old Kenyan male presented with fever of unknown origin, with negative initial infectious workups.
• Standard TB screening tests (Ziehl-Neelsen, GeneXpert) for Mycobacterium tuberculosis were negative.
• Diagnosis was confirmed via splenic core biopsy, revealing isolated splenic tuberculosis.

Findings:

• The patient experienced an initial worsening of symptoms during antituberculous therapy, consistent with a 'Paradoxical Reaction'.
• Despite the initial setback, the patient achieved a full recovery following treatment.
• This case underscores the diagnostic difficulty of splenic TB, even with negative initial tests.

Implications:

• Highlights the importance of considering tuberculosis in atypical presentations, even in immunocompetent hosts.
• Underscores the need for heightened clinical suspicion for splenic TB.
• Emphasizes awareness of potential paradoxical reactions during TB treatment, which can mimic treatment failure.