Splenic Tuberculous Abscess in Patients Positive for Human Immunodeficiency Virus: Report of Two Cases and Review

Khalil, Tariq; Uzoaru, Ikechukwu; Nadimpalli, Venkat; Wurtz, Rebecca

doi:10.1093/clinids/14.6.1265

Cited by 14 publications

(13 citation statements)

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“…The rate of detection of any focal lesion of the spleen increased to 28% with a 7.5 Mhz transducer (36 cases of microabscesses and 3 cases of macroabscesses), while the detection rate with a 3.5 Mhz transducer was only 2.2% (3 cases of macroabscesses). In other studies using conventional sonography, the rate of detection of splenic macroabscesses was 1-2% [1,3], and only a few case reports describing these lesions in HIV-infected patients have been published [11][12][13][14][15][16][17][18][19]. Our findings suggest that splenic microabscesses may be a frequent condition in HIV-infected patients with prolonged fever that goes undetected when conventional abdominal sonography is performed.…”

Section: Discussionmentioning

confidence: 59%

Etiology, Clinical Features and Outcome of Splenic Microabscesses in HIV-Infected Patients with Prolonged Fever

Bernabéu-Wittel

Villanueva

Pachón

et al. 1999

EJCMID

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A prospective study was conducted to determine the etiology, clinical features, and outcome in a series of 32 consecutively enrolled HIV-infected patients with prolonged fever in whom high resolution (7.5 Mhz) sonography revealed multiple splenic microabscesses. Conventional (3.5 Mhz) sonography showed no splenic abnormalities in any patients. The diagnoses were: tuberculosis (14), visceral leishmaniasis (7), disseminated Mycobacterium avium complex infection (5), Salmonella spp. bacteremia (2), lymphoma (2), disseminated Rhodococcus equi infection (1), disseminated Candida krusei infection (1) and Pneumocystis carinii pneumonia (1). Twenty-eight patients were followed up for six months and four were lost to follow-up. In 16 patients with a clinical cure and microbiological eradication, the findings on follow-up high resolution sonography were normal, and in two patients the microabscesses persisted; ten patients died. In conclusion, the findings suggest splenic microabscesses may be a frequent condition in HIV-infected patients with prolonged fever, being an unspecific manifestation of the opportunistic diseases causing fever of unknown origin in this population. They cannot be detected by conventional abdominal sonography, whereas high resolution sonography is a useful technique for their detection and follow-up.

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Section: Discussionmentioning

confidence: 59%

Etiology, Clinical Features and Outcome of Splenic Microabscesses in HIV-Infected Patients with Prolonged Fever

Bernabéu-Wittel

Villanueva

Pachón

et al. 1999

EJCMID

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“…Splenomegaly, pyrexia of unknown origin, with chills, weight loss, anorexia, diarrhea, abdominal pain, ascites, cough and lymphadenopathy, are some of the clinical findings of splenic tuberculosis in HIVpositive patients [1,8,26,[29][30][31][32][33][34][35][36][37][38][39][40]. 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].…”

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%

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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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“…Patient I had significant splenomegaly, and for patient 2 the findings on CT scan were highly suggestive of splenic abscesses, which appeared to respond to antimycobacterial therapy. Khalil et al [13] included M. tuberculosis and MAC in the differential diagnosis of splenic abscesses in HI V-positive patients. In the recent series of cases reported by Wald et al [3], four of seven patients with M. genavense infection had splenic involvement; two patients had splenomegaly, one patient's spleen ruptured during splenectomy, and examination ofautopsy-obtained specimens of the third patient's spleen revealed AFB.…”

Section: Microbiologymentioning

confidence: 99%

Disseminated Mycobacterium genavense Infection in Two Patients with AIDS

Gaynor

Clark²,

Koontz

et al. 1994

Clinical Infectious Diseases

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Mycobacterium genavense is a recently defined fastidious organism that has been identified as a cause of disseminated infection in patients with AIDS. We report the cases of two patients who had advanced AIDS and a clinical syndrome of fever, anorexia, abdominal pain, diarrhea, and weight loss. In addition, splenomegaly and lymphadenopathy were prominent in both cases, and in one patient's case radiographic findings were suggestive of splenic abscesses. Mycobacteria isolated from specimens of blood and bone marrow grew in liquid media but not on solid media.The results of DNA probe tests for Mycobacterium tuberculosis and Mycobacterium avium complex were false-positive for both patients. After treatment of the broth cultures to lyse red blood cells, the results of DNA probe tests were negative for these pathogens. Amplification and sequencing of 16S rRNA with use of the polymerase chain reaction indicated that the mycobacterial isolates from both patients had sequences identical to those previously reported for M.genavense. One patient survived 5 months after diagnosis, the other 2 months after diagnosis; only one patient responded (transiently) to antimycobacterial chemotherapy.Improvements in antimicrobial therapy have led to increased life-spans among patients infected with the human immunodeficiency virus (HIV). These severely immunocompromised individuals are at increased risk for mycobacterial infections through either reactivation or new acquisition of the microorganisms. Disseminated mycobacterial disease in the late stages of AIDS is most commonly the result of infection with Mycobacterium avium complex (MAC). Despite multidrug therapy, most patients' clinical conditions improve only minimally.In 1990 Hirschel et al. [1] reported the case of a patient with advanced AIDS who developed a syndrome characterized by fever, anorexia, diarrhea, and weight loss. Staining of biopsies of duodenum and bone marrow and blood buffy coat samples revealed acid-fast bacilli (AFB), which grew in liquid BACTEC medium but not on a variety of solid media. Case ReportsCase 1. A 35-year-old homosexual man was found to be seropositive for HIV in 1988. His CD4 lymphocyte count was 150/J,LL and he received therapy with zidovudine. Apart from a mild bout of Pneumocvstis carinii pneumonia and recurrent perirectal ulcers (caused by herpes simplex), his condition was stable until March 1992, when he developed constant abdominal pain, diarrhea, and weight loss. At that point his CD41ymphocyte count was 82/J,LL. Examination of stool specimens revealed only Giardia cysts, but he failed to respond to two courses of therapy with metronidazole. An abdominal ultrasonogram showed splenomegaly. The patient became anemic, and biopsy of bone marrow revealed AFB and multiple granulomata. The patient was treated with rifampin, ethambutol, clofazimine, ciprofloxacin, and isoniazid, but his symptoms persisted. Endoscopy revealed candidal esophagitis, and biopsy of the duodenum revealed AFB. A computerized tomography (CT) scan showed hepatospleno...

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Splenic Tuberculous Abscess in Patients Positive for Human Immunodeficiency Virus: Report of Two Cases and Review

Cited by 14 publications

References 0 publications

Etiology, Clinical Features and Outcome of Splenic Microabscesses in HIV-Infected Patients with Prolonged Fever

Etiology, Clinical Features and Outcome of Splenic Microabscesses in HIV-Infected Patients with Prolonged Fever

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

Disseminated Mycobacterium genavense Infection in Two Patients with AIDS

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