Splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum: Report of a case

We report a patient with splenic vein occlusion (SVO) secondary to tubercul osis. A 17-year-old male patient with mild epigastric pain and splenomegaly was found to have gastric varices by gastroscopy, and SVO by selective ang iography. At operation, the splenic vein was occluded by hard fibrous tissu e at the splenic hilum, and thus a splenectomy was performed. A microscopic examination of the tissue revealed caseous necrosis surrounded by epitheli oid cells and Langhans-type giant cells. Although there were no other findi ngs suggesting intestinal tuberculosis, it seemed that tuberculous lymphade nitis of the splenic hilum most likely caused the occlusion of the splenic vein. Because specific tests for tuberculosis were negative in both immunoh istochemical staining for bacille Calmette-Guerin and polymerase chain reac tion of DNA for Mycobacterium tuberculosis, the time of infection was assum ed to have occurred a long time before. SVO can sometimes be seen in pancre atic diseases, but this patient with tuberculosis appears to be the first s uch reported case in the English literature.