Nasim Afzal Tarar, Amjad Naseer Bhatti, Raheel Iftikhar.
Tuberculous splenic abscesses in an immunocompetent patient.
Pak Armed Forces Med J Jan ;57(1):90-1.

A 39 years old presented with low grade off and on fever and pain in the left upper abdominal region for one month. There was no history of cough, altered bowel habits, weight loss or contact with a case of tuberculosis. The patient was a nonsmoker. He was afebrile, with tenderness on deep palpation in left hypochondrium, spleen was not palpable. There was no palpable lymphadenopathy or jaundice. Laboratory investigations revealed raised 74 mm1hr ESR. Montoux test (1- TU PPD) was positive after 48 hours. Sputum smear was negative. Ultrasonography abdomen revealed normal sized spleen with multiple hypo echoic areas of various sizes, the largest measuring 2.8 x 3.6 cm. CT scan of the abdomen showed multiple small focal hypo dense lesions, suggestive of abscesses. CT – guided FNAC of the splenic lesions yielded frank pus. Smears showed epithelial cell granulomas, Langhan`s giant cells and few lymphoid cells with a necrotic background. Ziehl–Neelson stain revealed AFB. Mycobacterial culture and sensitivity testing of the pus that was aspirated showed a growth of M. tuberculosis after six weeks and the isolate was sensitive to first line of anti-Tuberculous drugs. The patient was found to be HIV negative by ELISA (Enzyme linked immunosorbent assay). He was diagnosed to have Tuberculous multiple splenic abscesses.

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