Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient.
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.
Barone
Bianca
B
Hospital Universitário Pedro Ernesto Universitary Hospital (HUPE), Rio de Janeiro, RJ, Brazil. bbarone@terra.com.br
Kreuzig
Patrícia Lago
PL
Gusmão
Patricia Medeiros
PM
Chamié
Daniel
D
Bezerra
Sabrina
S
Pinheiro
Pedro
P
Coscarelli
Pedro
P
Paiva
Daurita
D
Fonseca
Leila
L
Marsico
Anna
A
Cirigliano
André
A
Perez
Mário
M
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
D000995:Antitubercular Agents