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Case Reports
. 2017 Apr 24;10(1):162.
doi: 10.1186/s13104-017-2483-2.

Isolated splenic tuberculosis with subsequent paradoxical deterioration: a case report

Frederick Wangai  1 , Loice Achieng  2 , George Otieno  2 , Jacqueline Njoroge  2 , Tabitha Wambaire  2 , Jamilla Rajab  3
Affiliations
Case Reports

Isolated splenic tuberculosis with subsequent paradoxical deterioration: a case report

Frederick Wangai et al. BMC Res Notes. .

Abstract

Background: Isolated tuberculosis of the spleen has been described occasionally in literature, mostly in immunosuppressed individuals with various risk factors. Sequestration in the spleen makes such Mycobacterium tuberculosis infection difficult to diagnose. This report describes an extremely rare case of isolated splenic tuberculosis in an immunocompetent individual.

Case presentation: A 26 year old Kenyan male presented with pyrexia of unknown origin, with negative screening tests for bacterial, fungal and parasitic infections. Ziehl-Neelsen staining and GeneXpert tests were negative for M. tuberculosis. Diagnosis of isolated splenic tuberculosis was made on core biopsy of the spleen. The patient initially worsened upon treatment with antituberculous medication attributable to the 'Paradoxical Reaction' phenomenon, before making full recovery.

Conclusions: This case highlights the need to continuously be on the lookout for tuberculosis especially in unusual presentations, including subsequent paradoxical reaction which may be encountered.

Keywords: Case report; Core needle biopsy; Fine needle aspiration cytology; GeneXpert; Isolated tuberculosis of spleen; Paradoxical reaction; Spleen; Splenic tuberculosis; Tuberculosis.

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Figures

Fig. 1
Fig. 1
Computed tomography of the abdomen slices showing multiple splenic nodules
Fig. 2
Fig. 2
Chest computed tomography slices showing massive right pleural effusion and multiple splenic nodules
Fig. 3
Fig. 3
Splenic biopsy showing granulomas
Fig. 4
Fig. 4
CD68 stain showing positive histiocytes in granuloma
Fig. 5
Fig. 5
Ziehl–Neelsen stain positive for acid-fast bacilli
See this image and copyright information in PMC

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