Raviraj Sunil, Gogia A, Kakar A, Byotra S P
Department of Medicine, Ganga Ram Institute of Postgraduate Medical Education and Research Center (GRIPMER), Sir Ganga Ram Hospital, New Delhi 110060, India.
Case Rep Med. 2015;2015:130209. doi: 10.1155/2015/130209. Epub 2015 Jan 6.
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.
脾脏结核的发病率是一种罕见情况，孤立性脾结核是一种不寻常的现象，尤其是在免疫功能正常的个体中。我们遇到一例63岁男性，出现高热、体重减轻和持续一个月的全身乏力。体格检查时，他面色苍白，脾脏中度肿大且无压痛，无任何其他显著临床发现。他有全血细胞减少、血沉升高，结核菌素试验阳性。腹部超声和CT扫描显示脾脏肿大，无任何其他相关发现。结缔组织疾病标志物以及骨髓穿刺和活检对诊断均无帮助。因此进行了脾脏活检并送去做组织病理学检查。存在由上皮样肉芽肿和朗汉斯细胞包围的干酪样坏死提示诊断为结核。抗酸杆菌基因探针检测呈阳性。肺部或其他器官均未发现原发灶。患者经抗结核治疗后临床症状改善。
