Splenic Abscesses Due to Mycobacterium tuberculosis in Patients with AIDS

Wolff, Marcelo; Bitran, Jaime; Northland, Rebeca; Levy, Irene L.

doi:10.1093/clinids/13.3.373

Cited by 36 publications

(15 citation statements)

References 6 publications

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“…Splenic involvement is common in the milliary or disseminated forms of this mycobacteriosis [25], especially in HIV-positive patients with extra-pulmonary tuberculosis [1,[26][27][28], but this isolated form of presentation is very rare [1,8,14].…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports of spontaneous splenic rupture due to this mycobacterial infection, causing acute abdominal pain (both in HIV-positive patients and in otherwise normal individuals) [14]; there are also few reports of hypersplenism with bleeding tendencies (petechiae, purpura, ecchymoses) [15][16][17]41,42]. Since clinical findings are unspecific, complementary exams are needed for clinical investigation and differential diagnosis in relation to other splenic lesions that can be seen in patients who have AIDS, such as other opportunistic infections [1,8,26,27,29,[30][31][32][33][34][35][36][37][38][39][40], lymphomas and splenic Kaposi's sarcoma [1].…”

Section: Discussionmentioning

confidence: 99%

“…On abdominal ultrasound examination, the most suggestive findings are multiple small (< 1 cm), round hypoechogenic images, which are frequently hypodense on abdominal CT [6,8,11,21,26,[43][44][45][46][47][48][49][50]. Splenomegaly [6,27,[51][52][53][54] is also seen, and it is considered to be the most common feature of splenic involvement [55]. However, some reports point out the possibility of presentation with uniloculated pseudotumoral macronodules [5,6,11,22,46,56,57].…”

Section: Discussionmentioning

confidence: 99%

“…Follow-up ultrasonography 20 days -22 months after the splenic tuberculosis diagnosis should be made, with the intention to verify complete resolution of splenic abscesses [1,19,21,27]. In refractory cases, splenectomy is proposed [1,21,26,27,32,35,37,39,40].…”

Section: Discussionmentioning

confidence: 99%

“…In refractory cases, splenectomy is proposed [1,21,26,27,32,35,37,39,40]. Few studies report the use of corticoid adjuvant treatment in slow-responding cases, with the intention to prevent an eventual need for therapeutic splenectomy [8,19].…”

Section: Discussionmentioning

confidence: 99%

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

Barone¹,

Kreuzig²,

Gusmao³

et al. 2006

Braz J Infect Dis

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Barone¹,

Kreuzig²,

Gusmao³

et al. 2006

Braz J Infect Dis

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The Surgeon and AIDS

Saltzman

Williams²,

Gelfand³

et al. 2005

Arch Surg

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Background: Since the first reports on indications and outcome for abdominal procedures in the HIV/AIDS patient were published 20 years ago, the epidemiology and presentation of surgical illness have changed remarkably with the advent of new antiviral regimens. A review of the now occasional, but still important, role of the surgeon in contemporary treatment of HIV/AIDS is presented.Data Sources: Information was obtained by PubMed searches of medical journals, examination of reference lists, and Web resources.Study Selection: Articles on operative indications, outcomes, precautions, source of transmission, and pathophysiology of HIV/AIDS were selected.Data Extraction: Data was obtained from peerreviewed articles and references. Data Synthesis:The last 2 decades have seen a decrease in operative mortality from as high as 85% to approximately 15% with a corresponding improvement in morbidity. Surgical emergencies such as appendicitis occur in HIV patients with the same frequency as non-HIV patients and are treated with equivalent results. Concern about transmission of HIV in the operating room has lessened somewhat. Although still a hazard, the probability of HIV transmission with accidental exposure is low, with risks below 0.5% for percutaneous hollow-bore needles and less than 0.1% risk for mucus membrane exposure.Conclusions: Improved surgical outcomes together with of accurate data on the modes and likelihood of accidental transmission of HIV to members of the surgery team have resulted in the treatment of HIV/AIDS patients becoming an accepted part of routine surgical practice.

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