Isolated tuberculosis of the spleen presenting with fever of unknown origin in a vaccinated child

Abstract

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is more common in developing countries. Isolated splenic TB is typically found in trauma, miliary TB and immunocompromised status. We present a very rare case of an immunocompetent child with an isolated primary TB in the spleen. The child only had fever of unknown origin (FUO), and mild anaemia. The diagnosis was not made until splenectomy was performed. The patient took the quadruple therapy for TB, and follow-ups showed no recurrence. This case is unique because this child was immunocompetent with no history of trauma or active TB. TB diagnosis should never be ignored in FUO as this might prevent unnecessary procedures to the patient. Although the child was vaccinated with Bacillus Calmette–Guérin that usually protects against severe TB in first 5 years of life, it did not prevent from affecting the spleen.

A Case of Isolated Splenic Tuberculosis Presenting as a Splenic Abscess Complicated by Rupture Leading to Splenectomy in an Immunocompetent Male

“…TB is a significant infectious disease that remains prevalent in resource-poor countries. While its incidence has decreased in many developed nations, it continues to pose a significant public health challenge in many developing countries [ 5 ]. In 2022, TB tragically claimed the lives of approximately 1.3 million people worldwide.…”

“…An Indian study on splenic TB found that 62% of the cases were linked with pulmonary TB, and half of the patients were coinfected with HIV [ 6 ]. In immunocompetent patients, the spleen can become infected through trauma, as well as through hematogenous spread from the lungs in cases of miliary TB and from nearby organs [ 5 ].…”

“…In all these instances, the vanishing of splenic hypodensity and a full response to the medication served as additional confirmation of the diagnosis of a TB splenic abscess [ 8 ]. Although splenectomy is seldom needed in the treatment of spleen TB, it might become necessary in patients with splenic abscess or spontaneous rupture of the spleen or if the treatment does not yield any response [ 5 ]. In our case, a splenectomy was carried out because of an impending rupture of a splenic abscess.…”