Splenic tuberculous mass following anti-tuberculosis therapy was misdiagnosed as a splenic tumor: A case report

Abstract

BACKGROUND

Splenic tuberculosis is a rare disease, most commonly presenting with fever, weight loss, anemia, and splenic lesions. However, these signs and symptoms lack specificity and are easily confused with other abdominal diseases. Particularly in patients who have received anti-tuberculosis treatment, there may be no specific clinical symptom, leading to misdiagnosis and missed diagnosis. Moreover, due to the absence of specific symptoms in such patients, definitive diagnosis based solely on ultrasound and magnetic resonance imaging is challenging, typically requiring postoperative pathological examination for confirmation. Here, we report a case of asymptomatic splenic tuberculosis, analyzed the diagnostic and therapeutic processes, and discuss key considerations in managing splenic tuberculosis to enhance clinical diagnostic and therapeutic standards.

CASE SUMMARY

A 28-year-old male was admitted to Lishui Municipal Central Hospital on April 8, 2024, following the incidental discovery of an isolated splenic mass during a routine physical examination. Initial findings after admission suggested a cystic tumor within the spleen. After comprehensive diagnostic evaluations, the patient underwent laparoscopic partial splenectomy. The postoperative pathological diagnosis was a splenic tuberculosis. An interview with the patient revealed a history of tuberculosis that had been cured following anti-tuberculosis treatment, although no follow-up examination was conducted post-treatment. The patient’s recovery was uneventful and the postoperative prognosis was favorable.

CONCLUSION

Splenic tuberculosis should be considered for patients with risk factors for tuberculosis or a relevant history. This requires not only a thorough understanding of the patient’s medical history but also a comprehensive diagnostic evaluation, including imaging studies and even histopathological examinations, which are crucial for an accurate diagnosis.

Keywords: Splenic tuberculosis; Splenectomy; Tuberculosis; Pathological diagnosis; Case report

Core Tip: Although rare, splenic tuberculosis should be considered for patients with risk factors for tuberculosis or a relevant history. A high index of suspicion should be maintained for splenic masses with an unclear diagnosis to avoid missed diagnosis of splenic tuberculosis. When necessary, percutaneous needle biopsy may be performed to confirm the diagnosis, thereby avoiding unnecessary surgical intervention. Alternatively, after thorough evaluation, partial splenectomy may be considered to preserve spleen function.