Suspected Case of Secondary Splenic Tuberculosis Difficult to Differentiate from Pyogenic Splenic Abscess

Abstract

Splenic tuberculosis is known to occur due to hematogenous spread from the affected lungs. Ultrasonography shows non-specific features, including hepatosplenomegaly or abscess. Possible small hypoechoic nodules or larger hypoechoic mass-like areas are also observed. Sometimes it is challenging to differentiate splenic tuberculosis from a splenic pyogenic abscess. An 85-year-old man visited our clinic with abdominal discomfort and fatigue. He had a history of antituberculous medication. Upper abdominal ultrasonography showed an about 5 cm-sized pyogenic abscess-like lesion in the spleen. His symptoms and laboratory findings were not improved after a course of empirical antibiotic treatment. He was suspected of having secondary splenic tuberculosis and continued taking antituberculous medication. We are following up on his symptoms and radiologic images.