Case ReportIsolated primary tuberculosis of spleen-A rare entity in the immuno-competent patient

- Splenic involvement in Tuberculosis is generally miliary and in the immuno-compromised host.
- Isolated splenic tuberculosis in otherwise healthy patient is rare.
- Global burden of tuberculosis is largely contributed by sputum smear negative and extra-pulmonary cases.
- Need to accurately screen, diagnose and treat these category of cases.
- Use of minimally invasive surgery for diagnosis and therapy has been advocated.

IntroductionTuberculosis is a global public health concern, with 9.6 million affected individuals worldwide. Current screening and diagnostic regimes focus primarily on smear positivity, and hence, the rising numbers of Sputum negative and Extra-Pulmonary Tuberculosis has become a significant set-back to adequate diagnosis, disease notification and treatment, due to the large number of false negatives.Presentation of caseWe hereby describe an intriguing presentation of tuberculosis - A 23 yr old lady with no comorbid illness, came to us with ten month history of on and off pyrexia, weakness and left hypochondriac pain. On evaluation, two isolated hypodense lesions in the spleen were detected. Diagnostic laparoscopy and Splenectomy were performed and histopathology revealed features of primary tubercular abscess.DiscussionCommonly, abdominal visceral involvement is seen as a part of miliary tuberculosis in the immuno-compromised patient. However, in the absence of any co-morbidity and preserved immune function, this case depicts the rare possibility of primary isolated Tubercular splenic abscess in the normal healthy individual.ConclusionWe require a close eye and a keen sense of clinical acumen to accurately diagnose and treat smear negative and uncommon forms of Tuberculosis. Considering the growing prevalence and difficulty in disease control, there is need for greater knowledge and awareness to help mitigate the global burden of Tuberculosis.