SPLENIC ABSCESSES AND ABDOMINAL TUBERCULOSIS IN PATIENTS WITH AIDS

Tuberculous splenic abscesses do virtually not occur in immunocompeten t patients. Tuberculous abscesses have been reported only from areas, where the prevalence of both HIV infection and tuberculosis is very hi gh such as Central Africa. in our institution two of seven patients wi th AIDS and disseminated tuberculosis who were treated during the year 1994 developed tuberculous splenic abscesses. Both patients were resi dent in Central Europe and had fever and weight loss prior to admissio n. Multiple hypoechoic lesions up to 1.5 cm in diameter developed in t he spleen of both patients on day 11 and 16 after admission, respectiv ely. Initially no symptoms related to the splenic involvement and no l eucocytosis were seen in both patients. One patient developed leucocyt osis and left sided flank pain caused by a subtotal splenic abscess be cause the diagnosis and therapy of tuberculosis was delayed. Both pati ents responded promptly to triple drug antituberculous therapy without surgical intervention. We conclude that also in European patients mul tiple hypoechoic/hypodense lesions in the spleen of HIV positive patie nts are highly suggestive of disseminated tuberculosis. Follow-up by u ltrasound may help to establish the correct diagnosis and may further prevent unnecessary complications in these patients.