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Isolated hepatosplenic tuberculosis: a rare presentation with persistent fever in a 2-year-old female child
  1. Riya Tharakan,
  2. Sujonitha John,
  3. Jaidev Mangalore Devdas and
  4. Pavan Hegde
  1. Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
  1. Correspondence to Dr Jaidev Mangalore Devdas; jaidev.devdas{at}gmail.com

Abstract

A 2-year-old female child from South India presented with persistent fever for 3 weeks, pallor and hepatosplenomegaly. There was no history of contact with tuberculosis (TB) and BCG scar was absent. Tests for TB (Mantoux and gastric aspirate) were negative. Blood and bone marrow tests for other infections, inflammation and infiltration were inconclusive. Chest X-ray was normal. Ultrasound study (USS) of abdomen showed multiple microabscesses in the liver and spleen. USS-guided fine needle aspiration cytology from splenic lesion demonstrated epithelioid granuloma while bacteriology was negative. Commencement of anti-tubercular therapy (ATT) resulted in remarkable clinical improvement in a week with resolution of lesions on follow-up USS in 2 months. Isolated hepatosplenic TB in children, though rare, has a wide, non-specific clinical spectrum and potential of delaying diagnosis. Probability diagnosis and therapeutic trials of ATT are accepted approaches, using treatment response as indirect confirmation of the likely cause.

  • infection (gastroenterology)
  • infections
  • public health
  • paediatrics

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Footnotes

  • Contributors RT—initial draft, cared for the study patient. SJ—initial draft, cared for the study patient. JMD—final draft, cared for the patient. PH—final draft, cared for the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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