Solitary splenic tuberculosis: a case report and review of the literature.

BACKGROUND: Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Tuberculosis is an important health problem in developing countries. There are few cases of solitary splenic tuberculosis reported in the literature internationally. Solitary splenic tuberculosis is extremely rare and is mostly seen in individuals with immunosuppression. Patients susceptible to acquiring splenic tuberculosis usually have some risk factors such as immunosuppression, pyogenic infections, splenic abnormalities, spleen trauma, sickle cell disease, and so on (Basa JV, Singh L, Jaoude WA, Sugiyama G, Int J Surg 8C:117-119,2015). CASE PRESENTATION: Here we report a case of surgically confirmed mass-forming solitary splenic tuberculosis in a 64-year-old woman who presented with abdominal discomfort for two months, but with no other symptoms. Laboratory data provided no specific information for diagnosis. Abdominal ultrasonography revealed a large hypoechoic lesion within the spleen. Computed tomography scan of the abdomen showed a solitary hypodense lesion. A diagnosis of solitary splenic tuberculosis was confirmed after a splenectomy was performed and histopathological examination revealed splenic tuberculosis. CONCLUSIONS: Solitary splenic tuberculosis is rare and associated with an immunocompetent patient is extremely rare. It is hard to correctly diagnose it by US or CT scan.

Hepatosplenic tuberculosis simulating secondary malignant lesions with cholangitis.

BACKGROUND: Hepatic and/or splenic tuberculosis may simulate much pathology including malignancies, which can roam the diagnosis. Biopsy is necessary for diagnosis. The treatment allows healing and a cleaning of radiological lesions. CASE PRESENTATION: We report a case of a 48-old-black Senegalese woman, immunocompetent, hospitalized for febrile jaundice and poor general condition. Imaging and hepatic biopsy showed hepatosplenic tuberculosis with cholangitis, simulating secondary malignancies lesions. The outcome was favorable under treatment. CONCLUSION: In front of hepatic nodular lesions simulating malignancies in a tuberculosis endemic areas, achieving a liver biopsy helps rectify the diagnosis.

Systemic infection of Mycobacterium avium subspecies hominissuis and fungus in a pet dog.

A 3-year-old neutered female poodle with a long history of dermatophytic skin disease was presented with lethargy, anorexia and progressive weight loss. Abdominal ultrasonography revealed markedly enlarged mesenteric lymph nodes and multiple hypoechoic foci in the spleen. Cytology of the mesenteric lymph nodes and spleen showed granulomatous inflammation with fungal organisms and negatively stained intracytoplasmic bacterial rods consistent with Mycobacteria spp. Based on culture, multiplex polymerase chain reaction and sequence analysis, the bacterium was identified as Mycobacterium avium subspecies hominissuis. Despite treatment with antibiotics, the dog's condition deteriorated, and it died approximately 3 weeks after first presentation.

A rare presentation of splenic tuberculosis with a pseudocyst.

Splenic tuberculosis is an unusual manifestation of extrapulmonary tuberculosis, especially in immunocompetent hosts. It often poses diagnostic difficulties as microbiological confirmation is not easy. In this case report, we describe a case of pseudocyst of the spleen due to tuberculosis, which is a rare clinical presentation with only one case having been reported previously. A 24-year-old immunocompetent woman presented with pain in the abdomen, vomiting and fever. On evaluation the patient was found to have a cyst arising from the spleen. Splenectomy was performed. Pathological examination of the specimen revealed a pseudocyst with granulomas and giant cells consistent with tuberculosis. Cyst fluid analysis revealed lymphocyte predominance with high adenosine deaminase levels. The patient was started on 6 months of antituberculous therapy postoperatively. On follow-up, the patient was found to have gained weight and showed signs of well-being.

A case of mass-forming splenic tuberculosis: MRI findings with emphasis of diffusion-weighted imaging characteristics.

Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. The diagnosis and treatment of extrapulmonary tuberculosis involving the abdomen is still complicated owing to vague or non-specific clinical features. Although rare, isolated splenic involvement is one of the important manifestations of extrapulmonary tuberculosis, and imaging suspicion of the disease is essential. We report a case of surgically confirmed mass-forming splenic tuberculosis showing a layered pattern consisting of caseous necrosis with profound restriction of water molecules surrounded by an irregular rind of granulation tissue with less diffusion restriction on diffusion-weighted magnetic resonance imaging (DWI). In the differential diagnosis of neoplastic or non-neoplastic mass-forming lesions involving the spleen, this unique DWI feature could be helpful in characterizing splenic tuberculosis. The patient has been in clinically disease free status for nearly 20 months after splenectomy.

The clinical spectrum of patients with deficiency of Signal Transducer and Activator of Transcription-1.

STAT-1 (Signal Transducer and Activator of Transcription-1) is a key signaling component of interferon gamma responses. We present long-term manifestations in siblings with a mutation in the STAT1 gene, which include invasive salmonellosis, recurrent severe respiratory syncytial virus pneumonitis, and hepatosplenic mycobacterial disease, and we summarize all other reported cases with STAT-1 deficiency.

A Case of Mass-Forming Splenic Tuberculosis: MRI Findings with Emphasis of Diffusion-Weighted Imaging Characteristics

Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. The diagnosis and treatment of extrapulmonary tuberculosis involving the abdomen is still complicated owing to vague or non-specific clinical features. Although rare, isolated splenic involvement is one of the important manifestations of extrapulmonary tuberculosis, and imaging suspicion of the disease is essential. We report a case of surgically confirmed mass-forming splenic tuberculosis showing a layered pattern consisting of caseous necrosis with profound restriction of water molecules surrounded by an irregular rind of granulation tissue with less diffusion restriction on diffusion-weighted magnetic resonance imaging (DWI). In the differential diagnosis of neoplastic or non-neoplastic mass-forming lesions involving the spleen, this unique DWI feature could be helpful in characterizing splenic tuberculosis. The patient has been in clinically disease free status for nearly 20 months after splenectomy.

Clinical profile of patients having splenic involvement in tuberculosis.

BACKGROUND: Tuberculosis of spleen is very rare, usually seen in disseminated or miliary form of the disease and in patients having HIV infection. Splenic tuberculosis is currently described poorly in available literature. OBJECTIVES: In this series, we analyzed the clinical profile of patients having splenic involvement in tuberculosis. METHODS: Patients of tuberculosis (pulmonary and/or extra-pulmonary) with abnormal splenic parenchymal lesion on ultrasound were scanned in the light of demographic, clinical, radiological features, response to treatment and co-morbid illnesses. In selected eligible cases, CT scan abdomen and ultrasound guided FNAC of spelnic lesion was also done. RESULTS: Most of the patients (62%) were in the age group of 25-50 years with male/female ratio of 3:1. Constitutional symptoms such as fever (75%), anorexia (50%), and weight loss (10%) were common presentations apart from other symptoms such as pain abdomen (62%) and distention (12%). Half of these patients also had HIV infection. 62% patients had associated pulmonary tuberculosis. Other body sites involved were ascites (50%), intraabdominal lymph nodes (37%), pleural effusion (37%), cervical lymph nodes (12%), intestine (12.5%), etc. Ultrasonographic findings were multiple splenic abscess (62%), multiple diffuse, hypo-echoic foci (25%), solitary abscess and calcified granuloma (6%). About 44% patients became asymptomatic after receiving Category I treatment under RNTCP with complete clearance of initial sonographic abnormality in splenic parenchyma. CONCLUSION: The splenic involvement in tuberculosis seems to be more frequent in patients with HIV infection and in disseminated form of disease. Ultrasonography of the spleen is simple, easily available, affordable, non-invasive, imaging technique highly useful for the diagnosis of splenic involvement in tuberculosis. The sonographic findings should be correlated with overall clinical presentation with demonstration of tuberculosis at other body sites and image guided FNAC may be considered in cases with isolated splenic involvement.

GLS/IL-12-modified Mycobacterium smegmatis as a novel anti-tuberculosis immunotherapeutic vaccine.

OBJECTIVE: To study the effects and mechanisms of recombinant Mycobacterium smegmatis (rMS) carrying pZM03 (a co-expression plasmid encoding human granulysin [GLS] and murine interleukin 12 [IL-12]) on murine M. tuberculosis infection. DESIGN: BALB/c mice infected with M. tuberculosis were treated with normal saline, M. smegmatis, pZM03 or rMS. The number of viable bacteria in the lungs and spleens were counted to observe the therapeutic effects. The levels of IL-12 and interferon-gamma (IFN-gamma) in serum, and IFN-gamma and tumour necrosis factor-alpha (TNF-alpha) released from spleen lymphocytes were detected to observe the T-helper 1 (Th1) response. Secretory IgA (SIgA) in bronchoalveolar lavage fluid was measured to observe the mucosal immunity. The lungs and spleens were prepared for pathological analysis. RESULTS: The rMS group showed a significantly reduced number of colony-forming units compared to the other groups. The expression of GLS in the tissue, and increased levels of IL-12, IFN-gamma, TNF-alpha and SIgA, were found in the rMS group. The pathological changes in the lungs of the rMS group were localised, while those in the control group were extensive. CONCLUSION: rMS had immunotherapeutic effects associated with a switch to the Th1 response and the antibacterial activity of GLS.

Sterilizing activity of R207910 (TMC207)-containing regimens in the murine model of tuberculosis.

RATIONALE: The diarylquinoline R207910 (TMC207) has potent bactericidal activity in a murine model of tuberculosis (TB), but its sterilizing activity has not been determined. OBJECTIVES: To evaluate the sterilizing activity of R207910-containing combinations in the murine model of TB. METHODS: Swiss mice were intravenously inoculated with 6 log(10) of Mycobacterium tuberculosis strain H37Rv, treated with R207910-containing regimens, and followed for 3 months to determine relapse rates (modified Cornell model). MEASUREMENTS AND MAIN RESULTS: Quantitative lung and spleen colony-forming unit counts and bacteriological relapse rates 3 months after the end of therapy were compared for the following regimens: 2, 3, or 4 months of R207910 (J) and pyrazinamide (Z) combined with rifampin (R) or isoniazid (H) or both and 3 or 4 months of a moxifloxacin (M)-containing regimen and 6 months of the standard WHO regimen RHZ. All J-treated mice were culture negative after 4 months of therapy. The relapse rate in the group treated with 4 months of JHRZ was similar to that of mice treated for 6 months with the RHZ regimen (6 vs. 17%; P = 0.54) and lower than that of RMZ (6 vs. 42%; P = 0,03), a moxifloxacin-containing regimen that was the most active in mice on once-daily basis. CONCLUSIONS: Four months of treatment with some J-containing regimens was as effective as the 6-month standard regimen and more effective than 4 months of treatment with M-containing regimens. Supplementation of standard regimen (RHZ) with J or substitution of J for H may shorten the treatment duration needed to cure TB in patients.

Splenic tuberculosis: a case report.

Splenic tuberculosis is an unusual clinical phenomenon, especially in immunocompetent hosts. It often demonstrates diagnostic complexity, which makes the identification of the agent difficult. We encountered the case of a middle-aged immunocompetent male who claimed to be suffering from pain in the left hypochondriac region without any indication of cough, hemoptysis, weight loss or fever. When physically examined, he had splenomegaly without any other clinical findings. This was further confirmed by imaging. A splenectomy was performed, and samples were taken for histopathological examination and microbiological analysis. Gross examination of the specimen showed multiple nodules coalescing to form a large yellowish-white mass of solid consistency. Histopathological examination showed large areas of caseation surrounded by multiple granulomas of epitheloid cells and Langhan's type giant cells throughout the splenic pulp. PCR verified the diagnosis of Mycobacterium tuberculosis infection. No primary focus of infection was detected in the lungs or any other organs.

[Spleen and medullary tuberculosis]. / Gruzlica sledziony i szpiku.

Spleen is a rare extra-pulmonary tuberculosis manifestation. The spleen tuberculosis is caused by the blood derivative dissemination of mycobacteria. The symptoms can suggest a hematological disease, but it is difficult to make a diagnosis, especially when there are no pulmonary changes. The case of a 27-year-old woman with unclear etiology bone marrow hypoplasia was presented. The patient experienced: fever, body weight loss, pancytopenia and spleen enlargement with numerous focal echographic changes. The splenectomy revealed in a histopathologic examination productiva caseosa tuberculosis. The bone marrow trepanobiopsy revealed as well tuberculosis changes. The antimycobacteria treatment caused an improvement of the clinical state and the regression of symptoms.

Tuberculosis of the spleen: a case report.

A 40-year old Thai male presented with epigastric discomfort and weight loss without fever for 2 months. On examination, there was no hepatosplenomegaly or lymphadenopathy. His ultrasonogram showed multiple lesions in the spleen with enlarged abdominal lymph nodes. Pathology revealed caseating granulomas of the spleen and lymph nodes. No AFB were seen but PCR was positive for M. tuberculosis complex. The fever resolved within 3 days of surgery and the patient was treated with antituberculous drugs.

Laparoscopic diagnosis of splenic tuberculosis.

Isolated tuberculous splenic microabscesses are uncommon except in immunocompromized patients. The diagnosis is often made after splenectomy and histologic examination of the spleen. We report here a case of splenic tuberculosis in an immuno-competent patient. The diagnosis was made solely by laparoscopic biopsy of the spleen without the need for splenectomy. The patient was started on antituberculosis therapy with marked recovery. We believe that this might be the first reported case of isolated splenic tuberculosis ever diagnosed by laparoscopy only.

Unusual presentation of tuberculosis as a splenic mass.

Tuberculosis is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. Tuberculosis is mostly seen in immuno-compromised individuals, such as those with acquired immune deficiency syndrome or malignancies. Here we report a case of a spleen tuberculoma in a 29-year-old male patient with no known immune deficiency. He first presented with abdominal pain, and subsequent ultrasonographic examination revealed a splenic lesion of 10 cm in diameter. A computerized tomography scan of the abdomen confirmed the presence of a solitary, hypodense, septated cystic lesion. Lack of evidence supporting the presence of a splenic infection or a primary/metastatic malignancy prompted explorative surgery where a septated abscess formation was discovered and splenectomy was performed. Histopathological examination revealed granulomatous inflammatory changes with Langerhans-type giant cells, which are consistent with tuberculosis. For a period of two months, antituberculosis therapy with four drugs, isoniazid, rifampicin, pyrazinamide, and ethambutol, was carried out. Pyrazinamide and ethambutol were quitted at the end of two months. Therapy with isoniazid and rifampicin was planned for an additional 10 months. We would like to call attention to yet another atypical presentation of extrapulmonary tuberculosis.

Tuberculous splenic abscess--a case report and review of literature.

Splenic abscess due to tuberculosis is a rare condition and is mostly diagnosed in immuno-compromised hosts. A case of tuberculous splenic abscess detected incidentally after splenectomy without any underlying disease is reported in an immuno-competent patient.