Splenic tuberculosis: a rare entity.

To cite: Pratap V, Sinha SP, Bumb SS, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202828 DESCRIPTION Tuberculosis (TB) is a multisystem disease, 90% of which locates primarily in lungs, unlike isolated splenic tuberculosis, a rare form of extrapulmonary TB. Patients with AIDS or who are immunocompetent have been reported to be at a high risk for splenic TB. Some scholars insist that all patients with splenic TB are secondary to the previous infection of tubercle bacillus in other organs. A 53-year-old male patient reported of intermittent left hypochondrium aching pain, occurring after vomiting since past 2 months. He did not report fever, cough or any other respiratory problems. He was diagnosed to have type 2 diabetes mellitus 1 year ago. On examination, it was found that there was no organomegaly and no other abnormalities were detected. No primary focus was found. X-ray findings were normal. On further investigations, ultrasonography of the abdomen and pelvis was performed, which showed splenomegaly with multiple hypoechoic areas, suggestive of granuloma (figure 1), and a CT scan revealed hypodense area in the spleen (figure 2). Para-aortic lymphadenopathy and bilateral renal parenchymal changes were detected in both. Also, fine-needle aspiration cytology was reported to have granulomatous inflammation. Urine protein was present in traces. Serum uric acid (8.4 mg/dL) and calcium were high. Liver function tests were normal. These investigations suggested the patient of having splenic TB. The person was advised not to go for splenectomy as he was diabetic and removal of the spleen would increase chances of infections. The patient was started on antitubercular treatment which showed a rapid improvement in his condition.