Diagnosis and management of splenic tuberculosis: a case report and literature review

TL;DR

A 53-year-old woman was diagnosed with rare splenic tuberculosis after presenting with lymph node enlargement and a splenic mass, highlighting the need for histopathological evaluation for accurate diagnosis.

Contribution

This case report adds to the limited literature on splenic tuberculosis and emphasizes the importance of histopathology in diagnosis.

Findings

Splenic tuberculosis can present with non-specific symptoms like lymphadenopathy and splenic nodules.

Histopathology with acid-fast staining is critical for confirming tuberculosis in atypical cases.

Standard anti-tuberculosis treatment led to clinical improvement in the patient.

Abstract

Splenic tuberculosis is a rare form of extrapulmonary tuberculosis, that is often caused by hematogenous dissemination. A 53-year-old female presented with multiple enlarged lymph nodes and a splenic mass identified during a routine health check. Imaging revealed widespread lymphadenopathy and multiple splenic nodules, raising suspicion for lymphoma. The laboratory findings showed an elevated erythrocyte sedimentation rate and mild liver function abnormalities, with no significant tumor markers or inflammatory indicators. Histopathology of lymph node and splenic biopsies revealed granulomas with epithelioid cells and multinucleated giant cells. Acid-fast staining confirmed the presence of Mycobacterium tuberculosis, indicating the presence of splenic tuberculosis. The patient was treated with a standard anti-tuberculosis regimen and adjunctive hepatoprotective therapy, resulting in clinical improvement, and was discharged in stable condition. This case underscores the diagnostic challenges of splenic tuberculosis due to its non-specific presentation and highlights the importance of histopathological evaluation for timely diagnosis and treatment.

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