Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient

Abstract

We describe a case of a male patient, 38 years old, HIV-positive (most recent CD 4 count about 259/ mm 3 ), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Antituberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.

Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses

“…The common presentations of extra-pulmonary TB are lymphadenopathy, pleural effusion, bone and joint disease, abdominal TB, pericardial disease, meningitis and miliary disease [ 3 ]. Splenic TB, especially with abscess formation, is an unusual manifestation and occurs primarily in patients with concurrent HIV infection [ 4 , 5 ]. However, it may be found as part of severe, disseminated disease in non-HIV-infected patients, as in our reported case.…”

Splenic Tubercular Abscess in an Immunocompromised Patient–Rapid Diagnosis by Line Probe Assay

“…The strain was sensitive to RMP and INH [ [6,7]. In the present case there was no specific finding; patient came with the problem of pain in left hypochondrium, illness associated with fever of short duration.…”

Disseminated tuberculosis with lymphatic, splenic and scrotal abscesses: a case report

“…Lymph nodes have been generally reported as the most common nonpleural site [3,4]. This form is generally multifocal, with a peak onset during childhood and young adulthood [1,5]. Although it is a very common extrapulmonary presentation, lymph TB of the present case was misdiagnosed and treated as a nonspecific abscess with drainage and antibiotics.…”

“…Splenic TB, especially an abscess formation, is an unusual manifestation and usually occurs in patients with concurrent HIV infection [5,9]. However, it may be found in severe, disseminated disease in non-HIV patients, as in the presented case.…”