Fine needle aspiration biopsy of the spleen in pyrexia of unknown origin

To evaluate the diagnostic utility, value and potential risk of fine needle aspiration biopsy of spleen (sFNAB) in patients with splenomegaly in pyrex ia of unknown origin (PUO), a retrospective analysis of medical records and cytological material of 31 patients on whom FNAB was performed between Apr il 1994 and October 1997 was done. The patients were HIV- and presented wit h PUO. All other relevant investigations were negative. The spleen was eith er palpable or detected to have space-occupying lesions on ultrasonography (USG). The splenic aspirates showed tuberculosis in 11 patients (35.4%) and inconclusive or reactive changes in nine patients (25.8%). One case out of this group proved to be Kaposi's sarcoma on autopsy. The other diseases en countered were leishmaniasis (n = 3), non-Hodgkin's lymphoma (n = 4), funga l infections (n = 2), Hodgkin's lymphoma (n = 1). The patients who were dia gnosed as having tuberculosis had epithelioid cells, giant cells, necrosis and inflammatory cells in various combinations. AFB positivity was 63.6%. T he other cases which showed granulomas but no AFB were diagnosed on empiric al grounds and all responded to the anti-tuberculosis therapy. No complicat ions were encountered with the procedure. Therefore the authors conclude th at sFNAB is rewarding in patients where all other non-invasive modalities o f diagnosis have failed.