Disseminated Tuberculosis with Splenic Tuberculosis Abscess Rupture: A Rare Presentation

摘要

A 45-year-old HIV-negative man was admitted with left-sided abdominal pain. The first set of abdominal computed tomography (CT) scans revealed a splenic density suggestive of abscess formation. A chest X-ray also showed suspected cavitary changes at the left upper lobe. This was confirmed by chest CT (Figure 1 A). Patient was admitted to pulmonary ward for further evaluation and management. On the third day after admission, the patient developed acute-onset diffuse abdominal pain associated with rigidity. Emergent CT (Figure 1B) showed splenic abscess rupture, ascites accumulation, and surrounding fat stranding formation. Emergent splenectomy and drainage were performed. Gross pathology showed spleen with abscess rupture (Figure 1C). Microscopic examination showed granulomatous inflammation, and Ziehl-Neelsen staining demonstrated acid-fast bacilli (indicated by arrows in Figure 1D). Patient had a stable recovery and completed a 9-month regimen of antituberculosis medications (isoniazid, rifampicin, and ethambutol).