Splenic Tuberculosis

   A 29-year-old man with HIV presented with a 2-week history of left-sided abdominal pain. Six months earlier, he had begun treatment for pulmonary tuberculosis, but his regimen was later reduced to rifampin and isoniazid. On presentation, imaging revealed splenomegaly with multiple hypodense lesions. Splenectomy was performed to assess for malignancy, revealing necrotic nodules with purulent exudate. Histopathology showed granulomatous inflammation with caseous necrosis and acid-fast bacilli, though tissue cultures were negative. Real-time PCR confirmed Mycobacterium tuberculosis. The patient completed 9 months of four-drug therapy, including reinstated pyrazinamide and ethambutol. Final diagnosis: splenic tuberculosis in the context of immunosuppression.

   A 29-year-old man with HIV presented with a 2-week history of left-sided abdominal pain. Six months earlier, he had begun treatment for pulmonary tuberculosis, but his regimen was later reduced to rifampin and isoniazid. On presentation, imaging revealed splenomegaly with multiple hypodense lesions. Splenectomy was performed to assess for malignancy, revealing necrotic nodules with purulent exudate. Histopathology showed granulomatous inflammation with caseous necrosis and acid-fast bacilli, though tissue cultures were negative. Real-time PCR confirmed Mycobacterium tuberculosis. The patient completed 9 months of four-drug therapy, including reinstated pyrazinamide and ethambutol. Final diagnosis: splenic tuberculosis in the context of immunosuppression.