[Splenic abscesses caused by Mycobacterium tuberculosis in AIDS]

Up to 70% of the patients with tuberculosis and HIV infection develop extrapulmonary disease. Abdominal participation is generally of the lymph node type with splenic tuberculosis being rare.

Two cases of splenic tuberculosis from a series of 557 patients diagnosed with AIDS in a general hospital from March 1984 to March 1993 are described.

Splenic tuberculosis was the first manifestation of AIDS in these 2 patients. On pulmonary gammagraphy with gallium-67 both cases presented peripheral polyadenopathies and enhancement of hiliary and paratracheal lymph nodes. Abdominal ultrasound scan and computerized tomography revealed multiple hypoechogenic and hypodense splenic lesions, respectively, in the 2 cases. Diagnosis was made following isolation of Mycobacterium tuberculosis in blood cultures. Rapid response to tuberculostatic drugs was shown in one patient while the second responded favorably on the addition of glucocorticoids.

The homogenicity of the clinical-radiological picture of the 2 cases herein presented and those previously described in the literature allows the initiation of empiric anti-tuberculous treatment. A treatment schedule with glucocorticoids may be effective in patients presenting slow response to tuberculostatic treatment, thus avoiding therapeutic splenectomy.