Tubercular splenic abscess in an immunocompetent child: an unusual manifestation of abdominal tuberculosis

Abstract

Tuberculosis remains one of the most common infectious diseases worldwide with significant morbidity due to its varied pulmonary and extrapulmonary presentation. An extremely uncommon and rare manifestation of gastrointestinal tuberculosis in children is tubercular splenic abscess especially in an immunocompetent child. A nine year old immunocompetent girl presented with fever, weight loss and abdominal pain for two months. She had a strong positive history of tubercular contact. Examination revealed body mass index below the third percentile, pallor, hepatosplenomegaly with left upper quadrant tenderness. While gastric aspirate for acid fast bacilli (GA For AFB) and GeneXpert was negative, she had a strong ulcerative reaction to Tuberculin test with 15mm induration. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of extensive lymphadenopathy and a splenic abscess measuring 57×42×69 mm. GeneXpert of aspirated pus reported detection of Mycobacterium tubercular bacilli (MTB) confirming splenic abscess as tubercular. The patient received antitubercular therapy and underwent percutaneous drainage with good clinical and radiological response. Splenic abscess is itself very rarely encountered in children, making tubercular splenic abscess extremely rare. But lack of awareness regarding the same and delay in diagnosis may lead to serious morbidity and mortality.