Disseminated Tuberculosis with Presentation of Hypersplenism

Disseminated tuberculosis (DTB) refers to the concurrent involvement of at least two nonadjacent
organs or sites of the body, or involvement of the blood or bone marrow by tuberculosis.
Splenic invasion in TB can occur in either disseminated form or miliray tuberculosis. Occurrence of
hypersplenism in TB is very rare. In this article, a case of DTB with hypersplenism is presented.
A 23 years old man citizen of Kashan was admitted complaining of fever, night sweats, anorexia,
headache, weakness, shortness of breath and early satiety since 10 days ago. He was well until 9
months ago, when early satiety developed for the first time. Physical examination and
ultrasonography of the abdomen revealed huge splenomegaly. The results of his blood tests
showed pancytopenia but the X-ray and CT-scan of his chest were normal. Abdominal CT-scan
revealed a mild hepatomegaly, huge splenomegaly, para-aortic, retroperitoneal and left inguinal
lymphadenopathy. The patient underwent splenectomy. Pathologic examination of his liver, spleen
and lymph node biopsies revealed caseous necrosis and granuloma formation due to
TB. Finally, he was classified as a tuberculosis patient. After beginning the anti-tuberculosis
treatment, all of his signs and symptoms disappeared. At the present time, his general condition is
very good and he has no problem.
Huge splenomegaly and hypersplenism may occur during DTB. DTB can mimic lymphoma, so it
should be considered in differential diagnosis of a huge spleen.