HEPATOSPLENIC TUBERCULOSIS - A CAUSE OF PERSISTENT FEVER DURING RECOVERY FROM PROLONGED NEUTROPENIA

SETTING: Hepatosplenic abscesses in neutropenic patients, especially d uring the recovery phase, are almost always attributed to fungal infec tions. We report similar lesions due to Mycobacterium tuberculosis in neutropenic patients in a tertiary care centre in India. OBJECTIVE: To characterize the features of hepatosplenic tuberculosis in neutropeni c patients. DESIGN: Retrospective comparison of disease pattern and re sponse to treatment of hepatosplenic tuberculosis in febrile neutropen ia patients (four of 30 with severe prolonged neutropenia) and in non neutropenic patients diagnosed during the same 12-month period (n = 4, control group). RESULTS: The disease in the neutropenic patients typi cally presented during the recovery phase of neutropenia, with ultraso nic abnormalities similar to those seen in hepatosplenic fungal infect ions. In contrast to the marked organomegaly and typical granulomatous response found in the control group, the disease in the neutropenic p atients was characterised by an absence of organomegaly, non-involveme nt of other sites, poor inflammatory response and a high bacillary loa d. The initial response to therapy was satisfactory in both groups. CO NCLUSION: Tuberculosis needs to be considered in the diagnostic work-u p of hepatosplenic abscesses that occur during the recovery phase of n eutropenia.