Pyo pneumothorax revealing splenic tuberculosis abscess in a COVID-19 femmal: A case report

• Published in: International journal of surgery case reports 2022-07, Vol.96, p.107312-107312, Article 107312
• Main Authors: Bouassida, Imen, Hadj Dahmane, Mariem, Zribi, Hazem, Abdelkbir, Amina, Jaber, Chaker, Marghli, Adel
• Format: Article
• Language: English
• Subjects: Case Report; Covid-19; Pyopneumothorax; Splenic; Tuberculosis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107312

Splenic tuberculosis (ST) is an uncommon entity, especially in an immunocompetent patient. Therefore, diagnosis delays may be seen and can lead to fatal complications. We report a 37-year-old female with no medical history who presented to the emergency with a spontaneous left pyo pneumothorax. Reverse transcription-PCR analysis of COVID-19 was positive. Chest and abdominal Computed Tomography showed a ruptured splenic abscess with left pyopneumothorax. The diagnosis of splenic abscess with pleural fistulization was strongly suspected. Emergency surgery was decided for both therapeutic and diagnostic purposes. A left video thoracoscopy and splenectomy was performed. After histopathological examination, the diagnosis of ST ruptured in the pleural cavity was confirmed. The patient had a stable recovery and completed a 9-months regimen of anti-tuberculosis medications. ST has no characteristic symptoms and diagnosis may be delayed until life-threatening complications arise. Pyopneumoyhorax complicating ST is an exceptional evolution and rarely reported in the literature. In this case, the authors reported a ST discovered following respiratory signs related to an intrapleural splenic rupture in a young woman co-infection with COVID-19. ST is extremely rare and has no characteristic symptoms. The evolution is unpredictable and can lead to splenic rupture. This rupture can be intrathoracic making the diagnosis more difficult. •In areas where tuberculosis is prevalent, a splenic tuberculosis should be considered in the differential diagnosis of patients presenting with fever of unknown origin and splenomegaly.•The diagnosis can be made later when complications occur as well as spontaneous rupture of the spleen.•Although rare, chest rupture can occur and symptoms can be respiratory as well as pyopneumothorax or empyema, which can lead to inaccurate diagnosis and inappropriate treatment of the an underlying condition.