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CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 53-56

Isolated tuberculous splenic abscess in a HIV-positive patient


1 Department of Radiology, Federal Neuropsychiaric Hospital, Maiduguri, Borno State, Nigeria
2 Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria

Correspondence Address:
Ballah Akawu Denue
Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, PMB 1414, Borno State
Nigeria
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DOI: 10.4103/2384-5147.176323

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Tuberculous splenic abscess is a rare cause of pyogenic splenic abscess and occurs most often in the setting of an immunosuppressive state. It is a life-threatening condition associated with high mortality without prompt management. The diagnosis can be challenging as it has no characteristic clinical and radiological findings. Hence high index of suspicion, imaging studies including ultrasound-guided aspiration of the abscess under aseptic technique is helpful in its diagnosis. We report a 32-year-old patient with HIV infection who presented with 5 weeks history of abdominal pain, fever, anorexia, and significant weight loss. Abdominal ultrasound scan showed splenomegaly with multiple areas of mixed echogenicity. About 30 ml of foul smelling, creamy dark brown diagnostic, and therapeutic aspirate drained under trans-abdominal ultrasound scan guidance yielded positive for Mycobacterium tuberculosis (TB) under culture. Our patient died on the 12 th day of admission before bacteriology result. Tuberculous Splenic abscess could be fatal it not promptly managed; it should be considered in patients presenting with fever and abdominal pain especially in the setting of HIV infection. Due to lack of characteristic clinical and imaging findings, it poses a serious diagnostic dilemma with attendant consequences as occurred in our case. Ultrasound-guided aspiration of the abscess under aseptic technique is helpful in its diagnosis. Empiric anti-TB therapy should be considered in patients that failed to respond to broad-spectrum antibiotics in highly endemic areas.


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