Splenic Tuberculosis: A Case Managed Successfully in a Resource Limited Rural Setup

Splenic tuberculosis per se in an immunocompetent individual is very rare. We came across a case of a middle aged, immunocompetent female who presented with fever, weight loss, and left hypochondriac pain. She had earlier been treated for pulmonary tuberculosis one year back and declared cured after six months of antitubercular chemotherapy. Ultrasonography and computed tomography of abdomen revealed multiple hypoechoic lesions in the spleen. After the diagnosis of splenic tuberculosis, the patient was started on combination of antitubercular drugs under category two. She had a favourable response with antitubercular chemotherapy. Followup ultrasonography of abdomen after 3months of antitubercular therapy showed significant resolution of splenic hypoechoic lesions. We recommend that, splenic tuberculosis should be considered as a diagnostic possibility in patients belonging to endemic areas for tuberculosis, with splenic involvement, especially in those having a past history of tuberculosis, even though the individual is immunocompetent. This case highlights the fact that, these patients can be diagnosed by non-invasive imaging and managed by medical treatment effectively in a setting with limited resources.