Characteristics of Patients Having Splenic Involvement in Tuberculosis

Objective: One important, though poorly described, manifestation of Extra-pulmonary tuberculosis (EPTB) is that of splenic tuberculosis (TB). We aimed to identify the epidemiological, clinical and radiological characteristics of splenic TB in Southern Tunisia and to analyse its therapeutic and evolutionary modalities. Materials and methods: TB-patients (pulmonary and/or extra-pulmonary) with abnormal splenic parenchymal lesion on radiologial exploration were scanned in the light of demographic, clinical, radiological features and response to treatment. Results: We included 10 patients. Most of the patients (70%) were aged more than 25 years and the sex ratio was 0.25. Immunosupression was noted in 3 cases. Constitutional symptoms were common presentations apart from other abdominal symptoms. Most frequent ultrasound (US) findings were multiple focal hypoechoic lesions and splenomegaly. Computed tomography (CT) scan allowed a better characterization of the splenic lesions showing mainly micronodular spleen and hypodense nodudes. All patients received anti-TB drugs for a median of 13 months and splenectomy was not indicated in any case. The outcome was mostly favorable and death occurred in one case. Conclusion: The splenic involvement in TB include both immunocompetant and immunosuppressed patients. It is mainly reported in disseminated form of the disease. Radiological findings are highly useful for the diagnosis but should always be correlated with overall clinical presentation with demonstration of tuberculosis at other body sites.