Tuberculosis of the Spleen as a Cause of Fever of Unknown Origin and Splenomegaly
0
조회
0
다운로드
0
인용
0
참고문헌
초록
culosis,which is rare, warrants better definition in the current era of resurgence of tuberculosis. Methods:Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients. Results: All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV,and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes,cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period. Conclusions: In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement,and even in immunocompetent individuals.
Abstract
culosis,which is rare, warrants better definition in the current era of resurgence of tuberculosis. Methods:Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients. Results: All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV,and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes,cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period. Conclusions: In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement,and even in immunocompetent individuals.
참고문헌 (20)
- Porcel-Martin A, "Focal splenic lesions in patients with AIDS: sonographic findings", Abdom Imaging, 23, pp.196~200 (1998)
- Dubey SG, "Tubercular splenic abscesses in a patient with AIDS", J Assoc Physicians India, 44, pp.575~577 (1996)
- Sharma S, "Tuberculosis: a rare cause of splenic abscess", J Assoc Physicians India, 47, pp.740~741 (1999)
- Neki NS, "Isolated tubercular splenic abscess", J Assoc Physicians India, 49, pp.759~760 (2001)
- Bheerappa N, "Isolated splenic tuberculosis", Trop Gastroenterol, 22, pp.117~118 (2001)
- Jain A, "Isolated splenic tuberculosis", J Assoc Physicians India, 41, pp.605~606 (1993)
- Fleming AF, "Hematological diseases in the tropics. In Mansons’ tropical diseases. 21st ed.", pp.178~ (2003), Saunders
- Delpero JR, "Splenectomy for hypersplenism in chronic lymphocytic leukaemia and malignant non-Hodgkin's lymphoma", Br J Surg, 77, pp.443~449 (1990)
- "Management of non-respiratory tuberculosis", Lancet, 1, pp.1423~1424 (1986)
- Bhansali SK, "Abdominal tuberculosis: experiences with 300 cases", Am J Gastroenterol, 67, pp.324~337 (1977)
- Simu G, "Microscopic patterns in surgically removed spleens", Rom J Morphol Embryol, 37, pp.81~86 (1991)
- Ho PL, "Isolated splenic tuberculosis presenting with pyrexia of unknown origin", Scand J Infect Dis, 32, pp.700~701 (2000)
- Bastounis E, "Tuberculoma of the spleen: a rare but important clinical entity", Am Surg, 65, pp.131~132 (1999)
- Bora P, "Splenic tuberculosis presenting as hypersplenism", Ann Trop Paediatr, 21, pp.86~87 (2001)
- Fernandez-Miranda C, "Hepatosplenic tuberculous abscesses in a patient with polyarteritis nodosa", Am J Gastroenterol, 88, pp.1297~1298 (1993)
- Suri R, "Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis", Br J Radiol, 71, pp.723~727 (1998)
- Fukunaga H, "Sensitivity of acid-fast staining for Mycobacterium tuberculosis in formalin-fixed tissue", Am J Respir Crit Care Med, 166, pp.994~997 (2002)
- Wilde CC, "Case report: tuberculous hepatic and splenic abscess", Clin Radiol, 43, pp.215~216 (1991)
- Denzer U, "Minilaparoscopy-guided spleen biopsy in systemic disease with splenomegaly of unknown origin", Endoscopy, 34, pp.495~498 (2002)
- Nayyar V, "Response to antituberculous chemotherapy after splenectomy", J Intern Med, 233, pp.81~83 (1993)