Disseminated Tuberculosis with Presentation of Hypersplenism

Abstract

Disseminated tuberculosis (DTB) refers to the concurrent involvement of at least two nonadjacent organs or sites of the body, or involvement of the blood or bone marrow by tuberculosis. Splenic invasion in TB can occur in either disseminated form or miliray tuberculosis. Occurrence of hypersplenism in TB is very rare. In this article, a case of DTB with hypersplenism is presented. A 23 years old man citizen of Kashan was admitted complaining of fever, night sweats, anorexia, headache, weakness, shortness of breath and early satiety since 10 days ago. He was well until 9 months ago, when early satiety developed for the first time. Physical examination and ultrasonography of the abdomen revealed huge splenomegaly. The results of his blood tests showed pancytopenia but the X-ray and CT-scan of his chest were normal. Abdominal CT-scan revealed a mild hepatomegaly, huge splenomegaly, para-aortic, retroperitoneal and left inguinal lymphadenopathy. The patient underwent splenectomy. Pathologic examination of his liver, spleen and lymph node biopsies revealed caseous necrosis and granuloma formation due to TB. Finally, he was classified as a tuberculosis patient. After beginning the anti-tuberculosis treatment, all of his signs and symptoms disappeared. At the present time, his general condition is very good and he has no problem. Huge splenomegaly and hypersplenism may occur during DTB. DTB can mimic lymphoma, so it should be considered in differential diagnosis of a huge spleen.