Isolated splenic tuberculosis with subsequent paradoxical deterioration: a case report

• Published in: BMC research notes 2017-04, Vol.10 (1), p.162-162, Article 162
• Main Authors: Wangai, Frederick, Achieng, Loice, Otieno, George, Njoroge, Jacqueline, Wambaire, Tabitha, Rajab, Jamilla
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Anemia; Antibodies; Antigens; Antinuclear antibodies; Antitubercular Agents - therapeutic use; Asthma; Biopsy; Biopsy, Fine-Needle; Case Report; Case reports; Cellular biology; Chemotherapy; Ear; Eye; Family medical history; Fever; Fever - diagnostic imaging; Fever - drug therapy; Fever - immunology; Fever - microbiology; Gastrointestinal tract; HIV; Human immunodeficiency virus; Humans; Immune reconstitution; Immunocompetence; Immunosuppression; Infections; Inflammation; Isolated tuberculosis of spleen; Joint diseases; Kidneys; Liver; Lymphatic system; Lymphocytes; Male; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - pathogenicity; Mycobacterium tuberculosis - physiology; Neutropenia; Pain; Paradoxical reaction; Patients; Ribonucleic acid; RNA; Spleen; Spleen - diagnostic imaging; Spleen - microbiology; Spleen - pathology; Spleen - surgery; Splenic tuberculosis; Tomography; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis; Tuberculosis, Splenic - diagnostic imaging; Tuberculosis, Splenic - drug therapy; Tuberculosis, Splenic - immunology; Tuberculosis, Splenic - microbiology; Tumors; Ultrasonic imaging; Urine
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/s13104-017-2483-2

Isolated tuberculosis of the spleen has been described occasionally in literature, mostly in immunosuppressed individuals with various risk factors. Sequestration in the spleen makes such Mycobacterium tuberculosis infection difficult to diagnose. This report describes an extremely rare case of isolated splenic tuberculosis in an immunocompetent individual. A 26 year old Kenyan male presented with pyrexia of unknown origin, with negative screening tests for bacterial, fungal and parasitic infections. Ziehl-Neelsen staining and GeneXpert tests were negative for M. tuberculosis. Diagnosis of isolated splenic tuberculosis was made on core biopsy of the spleen. The patient initially worsened upon treatment with antituberculous medication attributable to the 'Paradoxical Reaction' phenomenon, before making full recovery. This case highlights the need to continuously be on the lookout for tuberculosis especially in unusual presentations, including subsequent paradoxical reaction which may be encountered.