title: A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula.
abstract: We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Kyong Joo
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jin Sae
authors.initials: JS
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Hosung
authors.initials: H
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sung Kook
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sung Sam
authors.initials: SS
authors.lastname: Ha
authors.affiliation: Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Mee Yon
authors.initials: MY
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D005471:Fluoroscopy; D005747:Gastric Fistula / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology; D013158:Splenic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014400:Tuberculosis, Splenic / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014463:Ultrasonography
chemical_list: D000995:Antitubercular Agents
keywords: Gastro-splenic fistula; Granuloma; Tuberculosis, splenic