title: Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient.
abstract: We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm(3)), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.
authors.affiliation: Hospital Universitário Pedro Ernesto Universitary Hospital (HUPE), Rio de Janeiro, RJ, Brazil. bbarone@terra.com.br
authors.forename: Bianca
authors.initials: B
authors.lastname: Barone
authors.forename: Patrícia Lago
authors.initials: PL
authors.lastname: Kreuzig
authors.forename: Patricia Medeiros
authors.initials: PM
authors.lastname: Gusmão
authors.forename: Daniel
authors.initials: D
authors.lastname: Chamié
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bezerra
authors.forename: Pedro
authors.initials: P
authors.lastname: Pinheiro
authors.forename: Pedro
authors.initials: P
authors.lastname: Coscarelli
authors.forename: Daurita
authors.initials: D
authors.lastname: Paiva
authors.forename: Leila
authors.initials: L
authors.lastname: Fonseca
authors.forename: Anna
authors.initials: A
authors.lastname: Marsico
authors.forename: André
authors.initials: A
authors.lastname: Cirigliano
authors.forename: Mário
authors.initials: M
authors.lastname: Perez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016896:Treatment Outcome; D014386:Tuberculosis, Hepatic / Q000175:diagnosis* / Q000188:drug therapy; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000188:drug therapy; D014400:Tuberculosis, Splenic / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents