Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient
| Autor: | Bianca Barone, Patrícia Lago Kreuzig, Patricia Medeiros Gusmão, Daniel Chamié, Sabrina Bezerra, Pedro Pinheiro, Pedro Coscarelli, Daurita Paiva, Leila Fonseca, Anna Marsico, André Cirigliano, Mário Perez |
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| Jazyk: | angličtina |
| Předmět: | |
| Zdroj: | Brazilian Journal of Infectious Diseases, Vol 10, Iss 2, Pp 149-153 |
| Druh dokumentu: | article |
| ISSN: | 1678-4391 1413-8670 |
| DOI: | 10.1590/S1413-86702006000200014 |
| Popis: | We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm³), 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. |
| Databáze: | Directory of Open Access Journals |
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