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Letter to the Editor
Isolated splenic tuberculosis in an immunocompetent patient
Tuberculosis esplénica aislada en un paciente inmunocompetente
Javier Páramo-Zunzuneguia,
Corresponding author
Javier.paramo@salud.madrid.org

Corresponding author.
, Silvia Benito-Barberoa, Eduardo Lisandro Hernández-Suárezb
a Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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she had high blood pressure above 160&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg and tachycardia at 101 beats per minute&#46; Laboratory study indicated leukocyte count 7550<span class="elsevierStyleHsp" style=""></span>c&#47;&#956;L &#40;reference 4&#8211;11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>c&#47;&#956;L&#41; &#40;neutrophils 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>c&#47;&#956;L and limphocytes 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>c&#47;&#956;L&#41;&#44; platelet count 539<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> &#40;reference 150&#8211;450<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#41;&#44; hemoglobin count 11&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;reference 12&#8211;16<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and C-reactive protein 108&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;L &#40;reference 0&#8211;5<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#46; Renal and liver function tests and tumor markers were normal&#46; Splenic length was 11<span class="elsevierStyleHsp" style=""></span>cm on Computed Tomography &#40;CT&#41; scan and ecography&#44; multiple hypodense non-enhancing nodules were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This suggested multiple infectious microabscesses versus neoplasm of the spleen&#46; Successive blood&#44; urine and stool cultures yielded no bacterial growth&#46; Serological tests for HIV&#44; hepatitis B and C&#44; <span class="elsevierStyleItalic">Salmonella</span>&#44; <span class="elsevierStyleItalic">Brucella</span>&#44; and <span class="elsevierStyleItalic">Bartonella</span> were negative&#46; <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> &#40;MTB&#41; was not detected in Ziehl-Neelsen &#40;ZN&#41; smears&#46; A tuberculosis Interferon-Gamma Release Assay &#40;IGRA&#41; was positive&#46; The Infectious Disease Committee decided to use empiric antimicrobial therapy against bacterial&#44; fungal and MTB infection&#44; as a diagnosis was yet to be confirmed&#46; Laparoscopy splenectomy was consensually performed to confirm the diagnosis and rule out oncological disease&#46; The histological examination revealed an expanded red pulp with the presence of granulomas&#44; with central necrosis and cellular debries&#44; surrounded by epithelioid histiocytes&#44; lymphocytes and isolated eosinophils&#46; Inmunohistochemistry and Flow Cytometry role out lymphoproliferative disorder&#46; Ziehl-Neelsen didn&#8217;t identify acid-fast bacilli&#46; Negativity for acid-fast bacili stains has a relatively low sensitivity and doesn&#8217;t rule out mycobacteria&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Nowadays they are mostly replaced by PCR techniques to identify the mycobacteria&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The most common anatomic sites affected by extrapulmonary TB are lymph nodes&#44; pleura&#44; bone and joints&#44; urogenital tract&#44; and meninges&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In our case&#44; we identified isolated splenic TB nodular disease in immunocompetent patient&#44; that is considered an infrequent finding in Spain&#44; not considered an endemic country&#46; Besides&#44; there are few cases of isolated splenic tuberculosis reported in the international literature&#44; and nearly none in western medical centers&#46; Splenic tuberculosis is typically associated with serious systemic illnesses such as immunosuppression&#44; bacterial endocarditis&#44; or sepsis as a result of haematogenous spread&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Diagnosis of isolated splenic tuberculosis is made by radiologic exams confirmed by pathologic examination of fine needle aspiration&#44; splenic biopsy or splenectomy specimen&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In our case CT scan couldn&#8217;t demonstrate an exact diagnosis or rule out malignancy&#44; so a laparoscopic splenectomy was performed&#44; after Infectious Disease clinicians consensus&#44; to confirm the diagnosis&#46; Surgical intervention in primary splenic tuberculosis is usually unnecessary as a mode of treatment&#46; However&#44; it can be indicated under particular conditions&#58; diagnostic purpose &#40;as in our case&#41;&#44; failure of medical treatment&#44; cytopenia or polycythemia&#44; tuberculous splenomegaly associated to portal hypertension&#44; failure of percutaneous abscess drainage or multiple splenic abscesses&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In the case of EPTB diagnosis&#44; including isolated splenic disease&#44; main experts and societies recommend a long-term antituberculous treatment &#40;12 months&#58; 2 initial months treatment with rifampicin&#44; isoniazid&#44; pyrazinamide and ethambutol followed by 10 months with rifampicin and isoniazid&#41;&#46;<span class="elsevierStyleSup">5</span> In our case&#44; the patient developed difficulty for oral intake of tablets&#44; so an intravenous treatment was administrated for 15 days&#44; followed by the consensual oral therapy&#46; The diagnosis was further corroborated when the patient showed remarkable improvement after antituberculous treatment and completed 10 months of rifampicin and isoniazid&#46; Evolution was satisfactory and relapse after recovery has not been identified after one-year follow-up&#46; Isolated splenic tuberculosis is a very uncommon phenomenon&#44; especially in nonendemic areas and immunocompetent patients&#46; Typically&#44; clinicians will consider more than one diagnostic hypothesis before reaching the final diagnosis&#46;</p></span>"
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                            0 => "I&#46; Solovic"
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                        "tituloSerie" => "Emerg Microbes Infect"
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                        "volumen" => "7"
                        "paginaInicial" => "102"
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                          0 => array:2 [
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                        "tituloSerie" => "World J Surg Oncol"
                        "fecha" => "2016"
                        "volumen" => "14"
                        "paginaInicial" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27250119"
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                    ]
                  ]
                ]
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                      "titulo" => "Tratamiento de la enfermedad tuberculosa pulmonar y extrapulmonar"
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                      ]
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ISSN: 23870206
Original language: English
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es en pt

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