Isolated splenic tuberculosis mimicking a solid splenic neoplasm in an immunocompetent patient: A surgical case report.

Introduction and importance: Tuberculosis is the leading cause of death by an infectious agent globally, especially among immunocompromised patients. Extrapulmonary tuberculosis (EPTB) can occur as a sequela of pulmonary tuberculosis through lympho-hematogenous or miliary spread, or can occur in isolation. EPTB rarely occurs in isolation in a single organ, especially in immunocompetent patients. Limited data exist on the incidence of isolated splenic tuberculosis in immunocompetent patients.

Case presentation: This report highlights a case of a 45-year-old immunocompetent female with a one-month history of dull left upper quadrant pain. A contrast-enhanced abdominal CT scan revealed a solitary hypodense, heterogeneous, solid splenic mass occupying most of the splenic parenchyma, with an initial preoperative diagnosis of a splenic hemangioma. A near-total splenectomy was done, with histopathology revealing chronic granulomatous infection, suggesting tuberculous infection. In our scenario, the patient had a favourable outcome, receiving a six-month course of anti-tuberculous therapy and no surgical complications postoperatively.

Clinical discussion: Splenic tuberculosis, although rare, can be classified as either micro-nodular, macro-nodular, miliary, or mixed types. The other subtypes commonly occur. However, macro-nodular splenic tuberculosis is rare and mimics benign and malignant splenic neoplasms radiologically, providing diagnostic challenges.

Conclusion: Isolated splenic tuberculosis should be considered in the differential diagnosis of solitary splenic lesions, even in immunocompetent patients in TB-endemic areas. While timely diagnosis and anti-tubercular therapy may preserve splenic tissue in selected cases, surgery remains inevitable when diagnosis is uncertain, complications arise, or medical therapy fails. The case further highlights the importance of multidisciplinary team management.