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Background: Hepatic and/or splenic tuberculosis may simulate much pathology including malignancies, which can roam the diagnosis. Biopsy is necessary for diagnosis. The treatment allows healing and a cleaning of radiological lesions., Case Presentation: We report a case of a 48-old-black Senegalese woman, immunocompetent, hospitalized for febrile jaundice and poor general condition. Imaging and hepatic biopsy showed hepatosplenic tuberculosis with cholangitis, simulating secondary malignancies lesions. The outcome was favorable under treatment., Conclusion: In front of hepatic nodular lesions simulating malignancies in a tuberculosis endemic areas, achieving a liver biopsy helps rectify the diagnosis.

Background: Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Tuberculosis is an important health problem in developing countries. There are few cases of solitary splenic tuberculosis reported in the literature internationally. Solitary splenic tuberculosis is extremely rare and is mostly seen in individuals with immunosuppression. Patients susceptible to acquiring splenic tuberculosis usually have some risk factors such as immunosuppression, pyogenic infections, splenic abnormalities, spleen trauma, sickle cell disease, and so on (Basa JV, Singh L, Jaoude WA, Sugiyama G, Int J Surg 8C:117-119,2015)., Case Presentation: Here we report a case of surgically confirmed mass-forming solitary splenic tuberculosis in a 64-year-old woman who presented with abdominal discomfort for two months, but with no other symptoms. Laboratory data provided no specific information for diagnosis. Abdominal ultrasonography revealed a large hypoechoic lesion within the spleen. Computed tomography scan of the abdomen showed a solitary hypodense lesion. A diagnosis of solitary splenic tuberculosis was confirmed after a splenectomy was performed and histopathological examination revealed splenic tuberculosis., Conclusions: Solitary splenic tuberculosis is rare and associated with an immunocompetent patient is extremely rare. It is hard to correctly diagnose it by US or CT scan.

A 3-year-old neutered female poodle with a long history of dermatophytic skin disease was presented with lethargy, anorexia and progressive weight loss. Abdominal ultrasonography revealed markedly enlarged mesenteric lymph nodes and multiple hypoechoic foci in the spleen. Cytology of the mesenteric lymph nodes and spleen showed granulomatous inflammation with fungal organisms and negatively stained intracytoplasmic bacterial rods consistent with Mycobacteria spp. Based on culture, multiplex polymerase chain reaction and sequence analysis, the bacterium was identified as Mycobacterium avium subspecies hominissuis. Despite treatment with antibiotics, the dog's condition deteriorated, and it died approximately 3 weeks after first presentation.

Splenic tuberculosis is an unusual manifestation of extrapulmonary tuberculosis, especially in immunocompetent hosts. It often poses diagnostic difficulties as microbiological confirmation is not easy. In this case report, we describe a case of pseudocyst of the spleen due to tuberculosis, which is a rare clinical presentation with only one case having been reported previously. A 24-year-old immunocompetent woman presented with pain in the abdomen, vomiting and fever. On evaluation the patient was found to have a cyst arising from the spleen. Splenectomy was performed. Pathological examination of the specimen revealed a pseudocyst with granulomas and giant cells consistent with tuberculosis. Cyst fluid analysis revealed lymphocyte predominance with high adenosine deaminase levels. The patient was started on 6 months of antituberculous therapy postoperatively. On follow-up, the patient was found to have gained weight and showed signs of well-being., (2014 BMJ Publishing Group Ltd.)

STAT-1 (Signal Transducer and Activator of Transcription-1) is a key signaling component of interferon gamma responses. We present long-term manifestations in siblings with a mutation in the STAT1 gene, which include invasive salmonellosis, recurrent severe respiratory syncytial virus pneumonitis, and hepatosplenic mycobacterial disease, and we summarize all other reported cases with STAT-1 deficiency.

Tuberculosis remains one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. The diagnosis and treatment of extrapulmonary tuberculosis involving the abdomen is still complicated owing to vague or non-specific clinical features. Although rare, isolated splenic involvement is one of the important manifestations of extrapulmonary tuberculosis, and imaging suspicion of the disease is essential. We report a case of surgically confirmed mass-forming splenic tuberculosis showing a layered pattern consisting of caseous necrosis with profound restriction of water molecules surrounded by an irregular rind of granulation tissue with less diffusion restriction on diffusion-weighted magnetic resonance imaging (DWI). In the differential diagnosis of neoplastic or non-neoplastic mass-forming lesions involving the spleen, this unique DWI feature could be helpful in characterizing splenic tuberculosis. The patient has been in clinically disease free status for nearly 20 months after splenectomy.

Background: Tuberculosis of spleen is very rare, usually seen in disseminated or miliary form of the disease and in patients having HIV infection. Splenic tuberculosis is currently described poorly in available literature., Objectives: In this series, we analyzed the clinical profile of patients having splenic involvement in tuberculosis., Methods: Patients of tuberculosis (pulmonary and/or extra-pulmonary) with abnormal splenic parenchymal lesion on ultrasound were scanned in the light of demographic, clinical, radiological features, response to treatment and co-morbid illnesses. In selected eligible cases, CT scan abdomen and ultrasound guided FNAC of spelnic lesion was also done., Results: Most of the patients (62%) were in the age group of 25-50 years with male/female ratio of 3:1. Constitutional symptoms such as fever (75%), anorexia (50%), and weight loss (10%) were common presentations apart from other symptoms such as pain abdomen (62%) and distention (12%). Half of these patients also had HIV infection. 62% patients had associated pulmonary tuberculosis. Other body sites involved were ascites (50%), intraabdominal lymph nodes (37%), pleural effusion (37%), cervical lymph nodes (12%), intestine (12.5%), etc. Ultrasonographic findings were multiple splenic abscess (62%), multiple diffuse, hypo-echoic foci (25%), solitary abscess and calcified granuloma (6%). About 44% patients became asymptomatic after receiving Category I treatment under RNTCP with complete clearance of initial sonographic abnormality in splenic parenchyma., Conclusion: The splenic involvement in tuberculosis seems to be more frequent in patients with HIV infection and in disseminated form of disease. Ultrasonography of the spleen is simple, easily available, affordable, non-invasive, imaging technique highly useful for the diagnosis of splenic involvement in tuberculosis. The sonographic findings should be correlated with overall clinical presentation with demonstration of tuberculosis at other body sites and image guided FNAC may be considered in cases with isolated splenic involvement.

Objective: To study the effects and mechanisms of recombinant Mycobacterium smegmatis (rMS) carrying pZM03 (a co-expression plasmid encoding human granulysin [GLS] and murine interleukin 12 [IL-12]) on murine M. tuberculosis infection., Design: BALB/c mice infected with M. tuberculosis were treated with normal saline, M. smegmatis, pZM03 or rMS. The number of viable bacteria in the lungs and spleens were counted to observe the therapeutic effects. The levels of IL-12 and interferon-gamma (IFN-gamma) in serum, and IFN-gamma and tumour necrosis factor-alpha (TNF-alpha) released from spleen lymphocytes were detected to observe the T-helper 1 (Th1) response. Secretory IgA (SIgA) in bronchoalveolar lavage fluid was measured to observe the mucosal immunity. The lungs and spleens were prepared for pathological analysis., Results: The rMS group showed a significantly reduced number of colony-forming units compared to the other groups. The expression of GLS in the tissue, and increased levels of IL-12, IFN-gamma, TNF-alpha and SIgA, were found in the rMS group. The pathological changes in the lungs of the rMS group were localised, while those in the control group were extensive., Conclusion: rMS had immunotherapeutic effects associated with a switch to the Th1 response and the antibacterial activity of GLS.

Rationale: The diarylquinoline R207910 (TMC207) has potent bactericidal activity in a murine model of tuberculosis (TB), but its sterilizing activity has not been determined., Objectives: To evaluate the sterilizing activity of R207910-containing combinations in the murine model of TB., Methods: Swiss mice were intravenously inoculated with 6 log(10) of Mycobacterium tuberculosis strain H37Rv, treated with R207910-containing regimens, and followed for 3 months to determine relapse rates (modified Cornell model)., Measurements and Main Results: Quantitative lung and spleen colony-forming unit counts and bacteriological relapse rates 3 months after the end of therapy were compared for the following regimens: 2, 3, or 4 months of R207910 (J) and pyrazinamide (Z) combined with rifampin (R) or isoniazid (H) or both and 3 or 4 months of a moxifloxacin (M)-containing regimen and 6 months of the standard WHO regimen RHZ. All J-treated mice were culture negative after 4 months of therapy. The relapse rate in the group treated with 4 months of JHRZ was similar to that of mice treated for 6 months with the RHZ regimen (6 vs. 17%; P = 0.54) and lower than that of RMZ (6 vs. 42%; P = 0,03), a moxifloxacin-containing regimen that was the most active in mice on once-daily basis., Conclusions: Four months of treatment with some J-containing regimens was as effective as the 6-month standard regimen and more effective than 4 months of treatment with M-containing regimens. Supplementation of standard regimen (RHZ) with J or substitution of J for H may shorten the treatment duration needed to cure TB in patients.

Splenic tuberculosis is an unusual clinical phenomenon, especially in immunocompetent hosts. It often demonstrates diagnostic complexity, which makes the identification of the agent difficult. We encountered the case of a middle-aged immunocompetent male who claimed to be suffering from pain in the left hypochondriac region without any indication of cough, hemoptysis, weight loss or fever. When physically examined, he had splenomegaly without any other clinical findings. This was further confirmed by imaging. A splenectomy was performed, and samples were taken for histopathological examination and microbiological analysis. Gross examination of the specimen showed multiple nodules coalescing to form a large yellowish-white mass of solid consistency. Histopathological examination showed large areas of caseation surrounded by multiple granulomas of epitheloid cells and Langhan's type giant cells throughout the splenic pulp. PCR verified the diagnosis of Mycobacterium tuberculosis infection. No primary focus of infection was detected in the lungs or any other organs.

Spleen is a rare extra-pulmonary tuberculosis manifestation. The spleen tuberculosis is caused by the blood derivative dissemination of mycobacteria. The symptoms can suggest a hematological disease, but it is difficult to make a diagnosis, especially when there are no pulmonary changes. The case of a 27-year-old woman with unclear etiology bone marrow hypoplasia was presented. The patient experienced: fever, body weight loss, pancytopenia and spleen enlargement with numerous focal echographic changes. The splenectomy revealed in a histopathologic examination productiva caseosa tuberculosis. The bone marrow trepanobiopsy revealed as well tuberculosis changes. The antimycobacteria treatment caused an improvement of the clinical state and the regression of symptoms.

A 40-year old Thai male presented with epigastric discomfort and weight loss without fever for 2 months. On examination, there was no hepatosplenomegaly or lymphadenopathy. His ultrasonogram showed multiple lesions in the spleen with enlarged abdominal lymph nodes. Pathology revealed caseating granulomas of the spleen and lymph nodes. No AFB were seen but PCR was positive for M. tuberculosis complex. The fever resolved within 3 days of surgery and the patient was treated with antituberculous drugs.

Isolated tuberculous splenic microabscesses are uncommon except in immunocompromized patients. The diagnosis is often made after splenectomy and histologic examination of the spleen. We report here a case of splenic tuberculosis in an immuno-competent patient. The diagnosis was made solely by laparoscopic biopsy of the spleen without the need for splenectomy. The patient was started on antituberculosis therapy with marked recovery. We believe that this might be the first reported case of isolated splenic tuberculosis ever diagnosed by laparoscopy only.

Tuberculosis is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. Tuberculosis is mostly seen in immuno-compromised individuals, such as those with acquired immune deficiency syndrome or malignancies. Here we report a case of a spleen tuberculoma in a 29-year-old male patient with no known immune deficiency. He first presented with abdominal pain, and subsequent ultrasonographic examination revealed a splenic lesion of 10 cm in diameter. A computerized tomography scan of the abdomen confirmed the presence of a solitary, hypodense, septated cystic lesion. Lack of evidence supporting the presence of a splenic infection or a primary/metastatic malignancy prompted explorative surgery where a septated abscess formation was discovered and splenectomy was performed. Histopathological examination revealed granulomatous inflammatory changes with Langerhans-type giant cells, which are consistent with tuberculosis. For a period of two months, antituberculosis therapy with four drugs, isoniazid, rifampicin, pyrazinamide, and ethambutol, was carried out. Pyrazinamide and ethambutol were quitted at the end of two months. Therapy with isoniazid and rifampicin was planned for an additional 10 months. We would like to call attention to yet another atypical presentation of extrapulmonary tuberculosis.

Splenic abscess due to tuberculosis is a rare condition and is mostly diagnosed in immuno-compromised hosts. A case of tuberculous splenic abscess detected incidentally after splenectomy without any underlying disease is reported in an immuno-competent patient.

Objective: To explore the clinical characteristics and diagnosis methods of abdominal tuberculosis., Methods: The clinical characteristics of abdominal tuberculosis in 57 cases proved by histopathology between 1958-2004 were retrospectively analyzed., Results: There were 39 cases of tuberculosis of the liver, 5 cases of the spleen, 8 cases of the pancreas, 3 cases of the stomach, 1 case involved both liver and spleen and 1 case involved both liver and stomach. Twenty-six patients were males and 31 female; with ages ranged from 17 to 68 years (mean 40.7 years) and most cases (71.9%) having extra-abdominal tuberculosis. Fever (75.4%), fatigue, anorexia, night sweating, weight loss (82.5%) and hepatosplenomegaly (57.9%) were the major clinical manifestations. Elevated erythrocyte sedimentation rate (ESR) (59.6%) and abdominal mass (64.9%) were found in most of the patients., Conclusions: The diagnosis of abdominal tuberculosis should be considered in all patients with fever of unknown origin, especially in those associated with hepatosplenomegaly, increased ESR and abdominal mass. Aspiration biopsy and laparotomy can provide correct diagnosis. The disease can be effectively treated with surgical intervention and antituberculous chemotherapy.

A 61-year-old woman was admitted with fever and headache of 10-day duration. She was found to have anemia, jaundice, and signs of meningitis. The erythrocyte sedimentation rate was increased and the tuberculin skin test was positive. A provisional diagnosis of miliary tuberculosis was made and antituberculous therapy was started, although no miliary lesions were seen on chest radiography. However, her condition rapidly deteriorated with diffuse opacification of both lungs and she died on the 7th hospital day. Postmortem examination revealed miliary tuberculosis in several organs but not in the lungs with acute respiratory distress syndrome accounting for the lung pathology. It should be noted that on rare occasions the lungs may not be involved by miliary tuberculosis.

Long-term survival of nonreplicating Mycobacterium tuberculosis (Mtb) is ensured by the coordinated shutdown of active metabolism through a broad transcriptional program called the stringent response. In Mtb, this response is initiated by the enzymatic action of RelMtb and deletion of relMtb produces a strain (H37RvDeltarelMtb) severely compromised in the maintenance of long-term viability. Although aerosol inoculation of mice with H37RvDeltarelMtb results in normal initial bacterial growth and containment, the ability of this strain to sustain chronic infection is severely impaired. Significant histopathologic differences were noted in lungs and spleens of mice infected with H37RvDeltarelMtb compared with controls throughout the course of the infection. Microarray analysis revealed that H37RvDeltarelMtb suffers from a generalized alteration of the transcriptional apparatus, as well as specific changes in the expression of virulence factors, cell-wall biosynthetic enzymes, heat shock proteins, and secreted antigens that may alter immune recognition of the recombinant organism. Thus, RelMtb is critical for the successful establishment of persistent infection in mice by altering the expression of antigenic and enzymatic factors that may contribute to successful latent infection.

A DNA vaccine encoding Ag85A from Mycobacterium tuberculosis was administered to guinea pigs by epidermal gene gun bombardment and its protective efficacy was determined. Vaccination with Ag85A DNA twice significantly reduced the severity of pulmonary pathology and number of pulmonary colony-forming units (CFU) (p<0.01). When immunogenic synthetic Ag85A peptide was used as a booster, lung pathology was improved significantly and pulmonary CFU were reduced dramatically. Neither Ag85A DNA nor BCG Tokyo protected the guinea pigs from hematogenous spread of tubercle bacilli to the spleen because splenic granulomas without central necrosis were recognized. When the vaccinated guinea pigs were followed up for 7 months, the pulmonary lesions became fibrotic in guinea pigs vaccinated with Ag85A DNA plus Ag85A peptide, or BCG Tokyo, and no tubercle bacilli were detected. The protective efficacy of the tuberculosis Ag85A DNA vaccine was improved significantly by peptide boosting. It is concluded that dosage and peptide boosting are important in the induction of higher protective efficacy by a tuberculosis DNA vaccine.

Isolated tuberculosis of the spleen is rare and difficult to diagnose. The features and management of this disease are discussed based on one case. A 52-year-old woman, presented with fever of unknown origin and splenomegaly. Ultrasonography and computed tomography demonstrated heterogeneous areas within the spleen. The diagnosis was made by a pathologic study of a splenic fragment obtained during laparotomy. When the spleen is the only organ involved by tuberculosis, the diagnosis is usually made by a pathologic study of splenic tissue obtained during laparotomy or percutaneous needle biopsy.

To gain a better understanding of the pathological role of natural killer (NK) T cells in murine tuberculosis, NKT knockout (KO) mice (J(alpha)281(-/-)mice) were utilized. Eight-week-old NKT KO mice of BALB/c origin and wild-type (WT) mice were infected with Mycobacterium tuberculosis Kurono strain by the airborne route using an airborne infection apparatus, and their capacity to control mycobacterial growth, granuloma formation, and cytokine production were examined. The NKT KO mice developed granulomatous lesions in the lungs; there was no statistically significant difference in pulmonary granuloma size between NKT KO and WT mice (p<0.01). The average CFU values increased 3 weeks post-infection, but decreased 9 and 11 weeks post-infection, in the lungs of NKT KO mice. When stimulated with Kurono strain in vitro, splenic cells from NKT KO mice produced less IFN-gamma than did those from WT mice. Expression of mRNA for IL-2, IL-4, IL-6, IL-10 and IL-12 p40 was slightly lower in NKT KO mice compared with WT mice. Our data indicate that NKT cells play a detrimental role in late-phase mycobacterial infection, although Th1 cells are essential in early-phase mycobacterial infection.

Objective: Generalized, or hematogenously disseminated, tuberculosis (TB) in patients with the acquired immune deficiency syndrome (AIDS) has been associated with a high incidence of cases remaining undiagnosed until postmortem. To better characterize generalized TB in the setting of AIDS, this report describes the clinical, laboratory, radiologic, and pathologic features of 20 fatal cases., Design: The medical records, autopsy protocols, and histologic material from patients with AIDS and concomitant TB were reviewed. All patients were autopsied at a tertiary care medical center during the years 1985-1997., Results: In 50% of our 20 cases, diagnosis was not made until postmortem. Signs and symptoms were few, including the absence of fever (temperature > or = 38 degrees C) in 55% of patients. Consistent laboratory abnormalities of a nonspecific nature were limited to hyponatremia (sodium <135 mmol/L) in 60%. Both peripheral and deep (thoracic and abdominal) lymphadenopathy, unusual in adults with TB, occurred in 45% and 95% of cases, respectively. In contrast to previous reports, all of the 6 cases of tuberculous meningitis presented as acute meningitis with a predominance of neutrophils in cerebrospinal fluid. Necrotizing encephalitis with extension of the acute inflammation into the superficial cortex was seen in all cases and tuberculous brain abscesses occurred in 50% of cases, a higher frequency than previously reported. Despite lung involvement in 90% of the cases, 33% of chest radiographs were interpreted as normal and disseminated mycobacterial disease was not suggested in the radiograph report in any of the other cases. Soft tissue abscesses in uncharacteristic locations such as the neck, mediastinum, and perirectal area occurred in these patients. Histologically, 95% of organs sampled showed inflammatory foci characterized by extensive necrosis with numerous neutrophils and/or karyorrhectic debris, numerous acid-fast bacilli, few or no epithelioid histiocytes, and no Langhans giant cells., Conclusion: Clinically and pathologically, generalized TB in the setting of AIDS is characterized by either unusual features or a lack of the typical features described for generalized TB in patients who do not have AIDS. This absence of classic features contributes to the high incidence of cases that remain undiagnosed until postmortem examination.

Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infrequently utilized because of the risk of haemorrhage. This study was carried out to evaluate the safety and efficacy of ultrasound guided FNAB of splenic lesions. 35 patients with focal splenic lesions underwent FNAB under real-time ultrasound guidance using a free hand technique. Ultrasound findings were single or multiple focal hypoechoic lesions (n = 33), focal hyperechoic lesion (n = 1) and diffuse heterogeneous echotexture (n = 1). Aspirations were performed with 22 G spinal needles using either the subcostal or the intercostal approach. Definite cytological diagnosis was made in 22 patients (62.8%), including tuberculosis in 10 patients, lymphoma in seven patients, extramedullary haematopoiesis in two patients and aspergillosis, histoplasmosis and bacterial abscess in one patient each. FNAB was negative in 12 patients because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intraabdominal bleeding, which was managed conservatively. In conclusion, splenic FNAB performed under ultrasound guidance is a safe and accurate method in the diagnosis of focal splenic lesions.

Tuberculoma of the spleen has been an extremely rare entity during the last decades in the Western world. We describe a case in a young, HIV-negative woman who was evaluated for fever of unknown origin. The workup was initially negative, and she was treated successfully with steroids and nonsteroidal anti-inflammatory analgesics. Recurrence of the fever and an abnormal CT of the abdomen lead to an exploratory laparotomy, which revealed a subcapsular caseous material containing splenic abscess. The very few cases reported in the literature, and the increasing incidence of extrapulmonary tuberculosis due to the alarming numbers of immunodeficient patients that a surgeon may encounter are also discussed.

Although barium studies and CT are useful in assessing abdominal pathology in tuberculosis, imaging findings are not always specific and a histopathological or bacteriological confirmation is often required. The aim of the present study was to evaluate the role of ultrasound (US) guided fine needle aspiration cytology (FNAC) in the diagnosis of abdominal tuberculosis in patients with non-palpable lesions detected on US/CT. FNAC was performed on 31 sites in 30 patients. The sites included enlarged lymph nodes (n = 14), focal lesions in liver (n = 2) and spleen (n = 8), and thickened bowel in the ileocaecal region (n = 7). The results were classified cytomorphologically into four groups: (1) definite evidence of tuberculosis; (2) presumptive evidence of tuberculosis; (3) suggestive of tuberculosis; and (4) negative for tuberculosis. 18 of the 31 FNACs (58%) revealed a positive diagnosis of tuberculosis (definite evidence in nine patients and presumptive evidence in nine patients). 13 of the 31 FNACs (42%) showed either necrosis alone (n = 4) or negative results (n = 9). Zeihl-Neelson staining for acid-fast bacilli on direct smear was positive in only nine patients (29%). Splenic and lymph nodal FNAC had a high sensitivity (87.5% and 78.6%, respectively) in the diagnosis of tuberculosis. None of the bowel and liver FNACs was diagnostic. No complications were encountered. US guided FNAC offers a safe and accurate method of achieving a diagnosis in patients with suspected abdominal tuberculosis who present with radiologically demonstrable but non-palpable lesions, especially those involving lymph nodes and spleen.

Splenic tuberculosis is rare and delay in diagnosis is common. We present two cases of splenic tuberculosis with their appearance on CT. The CT findings were multiple, round or ovoid, low-density lesions without calcification. Except for non-specific lymphadenopathy no abnormality nor history suggestive of tuberculosis was revealed prior to laparotomy. Although CT does not confirm a diagnosis of splenic tuberculosis, it would be a valuable examination to define the extent of disease and guide aspiration biopsy.

The purpose of this study was to review autopsy and gallium scan findings in two different acquired immune deficiency syndrome (AIDS) patient populations who had a confirmed diagnosis of tuberculosis (TB) to identify organs involved and accuracy of clinical diagnosis. The first group was comprised of 29 autopsies between January 1982 and December 1994, including only 18 patients who were diagnosed before death. Organs most commonly involved were the lymph nodes (59%), lungs (56%), spleen (53%), liver (45%), and kidneys (37%). Other opportunistic infections were present in 18 (59%) of autopsies, with more than one opportunistic infection present in 11 (37%) of the autopsies. Lungs were involved in 79% of all autopsies. The second population group included 94 patients with AIDS with a proven diagnosis of TB, only 24 of whom had gallium scans in the period between January 1992 and December 1994. Chest x-ray results were negative in 4 patients (17%); gallium scan results were positive in 16 patients (66%). The reasons for false-negative gallium scan results were due to anti-tuberculous treatment for periods varying from 2-21 months in 7 patients or the presence of extra pulmonary tuberculosis. The sites of TB involvement in the chest were: lung parenchyma in 5 patients (19%, 4 in mid and lower lung, and 1 in upper fields). There was lymph node involvement in all 16 patients (24 locations with mediastinal involvement in 23%, supraclavicular 23%, axillary 11%, retroperitoneal 11%, and inguinal region in 4%. We conclude that (1) tuberculosis in patients with AIDS behaves similar to primary tuberculosis; (2) the combination of chest x-ray and gallium imaging is sensitive for the diagnosis of pulmonary tuberculosis in patients with AIDS; (3) the involvement of mediastinal lymph nodes in gallium scans in the presence or absence of chest x-ray abnormalities should raise the possibility of TB involvement in patients with human immunodeficiency virus; (4) anti-TB treatment decreases the sensitivity of gallium scan.

A 34-years male was admitted to our hospital with a hypochondria pain and low grade fever. Abdominal CT revealed an encapsulated 8 x 3 cm low density lesion on the surface of the liver (S5, S8) and multiple low density lesions of the spleen. The patient had already been treated with anti-tuberculous drugs for the past 7 months after being diagnosed as tuberculous pleuritis. Although echo-guided percutaneous needle biopsy was tried for the hepatic lesion, no special finding was obtained. Therefore a diagnostic laparotomy was performed and the hepatic lesion was resected. Abscess formation of the resected lesion was noted. Histopathology of the lesion revealed epithelioid granuloma, but microscopy, culture and PCR for tuberculosis revealed negative results. Abdominal CT, 3 weeks after surgery, revealed enlargement of the splenic lesion. Splenectomy was carried out to avoid splenic rupture. Multiple abscess of the resected spleen was noted. Pathological finding, Ziehl-Neelsen stain and PCR for tuberculosis confirmed the diagnosis of tubercular splenic and liver abscess. Although tubercular liver and splenic abscess are very rare recently, it should be included in the differential diagnosis of unknown hepatic and splenic lesions.

Purpose: To determine whether sonograms of the liver and spleen, obtained with 5-MHz linear-array transducers, aid in detection of hepatosplenic microabscesses in patients with acquired immunodeficiency syndrome (AIDS)., Materials and Methods: Abdominal sonographic examinations (n = 111) were performed in 102 consecutive patients with AIDS. A 3.5-MHz sector transducer was used in each study, with additional images of the hepatic and splenic parenchyma obtained with a 5-MHz linear-array transducer. Each study was reviewed without benefit of the 5-MHz images, and categories of the hepatic and splenic parenchyma were as follows: 1, lesions definitely present; 2, lesions possibly present; and 3, lesions absent. The 5-MHz images were subsequently reviewed, and studies were recategorized. Findings were correlated with results of pathologic examination., Results: The 5-MHz scans enabled identification of focal hepatic or splenic lesions in 14 of 96 studies placed in category 2 or 3 on the basis of the 3.5-MHz sector scans., Conclusion: In patients with AIDS, 5-MHz sonograms of the liver and spleen enable detection of microabscesses not confidently identified on 3.5-MHz scans.

A 48-year-old male had suffered from body weight loss and general malaise for 2 months. Abdominal computed tomography showed a dilated intrahepatic duct with stones and a hypodense nodular mass in the spleen. A splenectomy and distal pancreatectomy were performed under the preoperative impression of a malignancy. Histological examination of the specimens revealed tuberculosis.

Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis, without any HIV infection. All patients had focal splenic lesions in the form of scattered hypoechogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach.

Pseudotumoral or macronodular hepatosplenic tuberculosis (HSTB) is rare. Only 31 cases have been documented in imaging literature so far. Presented is the clinico-imaging review with five additional new cases of this uncommon variety. Due to nonspecific wide spectrum of imaging appearances, biopsy is mandatory in almost all cases. Clinical recovery and resolution of lesions on imaging may not be directly proportional.

A case of multiple tuberculomas of the spleen, detected as hypoechoic masses on ultrasound and subsequently proved at operation and histopathology, is presented. This was the only manifestation of the disease.

The tests on guinea pigs proved that amniocene (a tissue preparation) has a double action (antiinflammatory and potentiating repair processes in the foci of tuberculous lesions). This action manifests itself depending on the type of tuberculous inflammation and produces an effect upon the involution of experimental tuberculosis.

Two cases of a combination of a malignant blood disease with latent tuberculosis are presented. One of the patients was with acute leukemia and the other one was with non-Hodgkin's malignant lymphoma (Lymphosarcoma). The blood disease dominated the clinical picture and determined the severity of the course and the lethal outcome. The post mortem examination revealed hepatosplenic form of miliary tuberculosis in both patients. In one of the patients caseous tuberculosis of the bronchopulmonary, peribronchial and periportal lymph nodes was found, too. The tuberculous process had a latent course without characteristic manifestations but it also led to worsening of the patients' condition.

Tuberculosis of the lymph nodes is not rare today. However tuberculosis of the spleen has been very rare even in the past when many patients had suffered from tuberculosis. The appearance of Hodgkin's disease following tuberculosis is an extremely rare condition. It has thought that deficiency of cellular immunity was responsible for both tuberculosis and malignancy. We present a 44-year-old man in whom lymph node and spleen tuberculosis antedated the clinical onset of Hodgkin's disease for three years. The patient was successfully treated with tuberculostatics until he developed Hodgkin's disease; he was treated according to MOPP protocol. Six years after the onset of disease nodular lesion of the spleen was detected and splenectomy was carried out. The enlarged spleen, g in weight, was removed with tuberculoma in the lower pole, 4 cm in diameter. The tuberculostatic therapy for a year followed splenectomy. The patient stayed symptom-free, with no sign of tuberculosis. He is in the remission stage of Hodgkin's disease with normal clinical and laboratory data.