No abstract

A 48-year-old male presented to medicine outpatient department with abdominal distension of one month duration, which was progressive and worsened in the last one week. He did not take any treatment at this stage. There was also history of fever with thrombocytopenia (which was documented in the previous blood investigation report) one week back and treated conservatively for the same. There was no history of any bleeding manifestations. The patient also complained of weight loss which was not quantifiable, associated with decreased appetite for last one month. He used to take alcohol for last 10 years occasionally but never smoked. On examination, his vitals were stable. Abdomen examination showed diffuse distension of the abdomen with free fluid and there were dilated veins over the abdominal wall. Rectal examination was normal. Respiratory system examination showed bilateral occasional rhonchi. Other system examination was normal.

Vascular thrombosis is one of the complications of tuberculosis. Deep vein thrombosis and pulmonary thrombosis have been reported with pulmonary and extrapulmonary tuberculosis. Splenic involvement in abdominal tuberculosis is among the rarest manifestations. Disseminated tuberculosis is predominantly reported in rheumatoid arthritis following ingestion of biological agents. Here, we report a case of disseminated tuberculosis in a rheumatoid arthritis patient who was on steroids and methotrexate for a long period, presenting with multiple splenic lesion and portal vein thrombosis, which was not reported earlier. She was treated with antitubercular drugs, anticoagulants and showed improvement.