Tuberculosis

Tuberculosis

The diagnosis of tuberculosis should be considered in young adults with splenomegaly presenting with asthenia, loss of weight and fever. Tuberculosis of the spleen may produce portal hypertension or, rarely , cold abscess. CT shows small low-attenuation areas with central enhancement in the acute stage and MRI shows hypointense lesions ( Figure 70.11 ). Multidrug chemotherapy with four drugs in the intensive phase of 2 months followed by two drugs in the maintenance Adolph Weil , 1848–1916, physician, Dorpat (now Tartu), Estonia, described leptospirosis icterohaemorrhagica in 1886. Philippe Charles Ernest Gaucher , 1854–1918, dermatologist, Paris, France. Sir George Frederic Still , 1868–1941, Professor of Diseases of Children, King’s College Hospital, London, UK, described chronic articular rheumatism in children in 1896. Augustus Roy Felty , 1895–1964, physician, Hartford, CT , USA, described the combination of arthritis, splenomegaly and leukopenia in 1924 while still a medical student at Johns Hopkins School of Medicine, Baltimore, MD, USA. Thomas Hodgkin , 1798–1870, lecturer in morbid anatomy and curator of the museum, Guy’s Hospital, London, UK, described lymphadenoma in 1836.

Infective Bacterial Spirochaetal Viral Protozoal and parasitic Blood disease Acute leukaemia Chronic leukaemia Pernicious anaemia Polycythaemia vera Erythroblastosis fetalis Metabolic Rickets Amyloid Porphyria Gaucher’s disease Circulatory Infarct Portal hypertension Segmental portal hypertension Collagen disease Still’s disease Felty’s syndrome Non-parasitic cysts Congenital Acquired Neoplastic Angioma Primary /f_i brosarcoma Hodgkin’s lymphoma Other lymphomas Myelo /f_i brosis HIV, human immunode /f_i ciency virus. Typhoid and paratyphoid Typhus Tuberculosis Psittacosis Septicaemia Splenic abscess Weil’s disease Syphilis Infectious mononucleosis HIV-related thrombocytopenia Malaria Schistosomiasis Trypanosomiasis Kala-azar Hydatid cyst Tropical splenomegaly Idiopathic thrombocytopenic purpura Hereditary spherocytosis Autoimmune haemolytic anaemia Thalassaemia Sickle cell disease (Pancreatic carcinoma, splenic vein thrombosis)

phase for a total duration of 12–18 months is preferred for treatment of extrapulmonary tuberculosis. Splenectomy is not normally required and is made di ffi cult by inflammatory adhesions. Typical epithelioid cell granulomas are seen in the histopathology of the spleen only if splenectomy had to be performed ( Figure 70.12 ).

Figure 70.10 Computed tomography scan showing a multiloculated abscess (arrowheads) in the enlarged spleen. This was managed successfully by percutaneous drainage under ultrasound guidance. Figure 70.11 T2-weighted axial magnetic resonance image showing multiple hypointense lesions (arrows) of varying sizes in the spleen, suggestive of tuberculosis (courtesy of Dr Ruchi Rastogi, New Delhi, India).