A Case of Splenic Tuberculosis Forming a Gastrosplenic Fistula

Kyong Joo Lee; Jin Sae Yoo; Hosung Jeon; Sung Kook Cho; Ji Hyun Lee; Sung Sam Ha; Mee Yon Cho; Jae Woo Kim

doi:10.4166/kjg.2015.66.3.168

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Lee, Yoo, Jeon, Cho, Lee, Ha, Cho, and Kim: A Case of Splenic Tuberculosis Forming a Gastrosplenic Fistula

Case Report

Korean J Gastroenterol 2015;66(3):168-171.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.3.168

A Case of Splenic Tuberculosis Forming a Gastrosplenic Fistula

Kyong Joo Lee, Jin Sae Yoo, Hosung Jeon, Sung Kook Cho, Ji Hyun Lee, Sung Sam Ha, Mee Yon Cho¹, Jae Woo Kim

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

¹Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to: Jae Woo Kim, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea. Tel: +82-33-741-1222, Fax: +82-33-741-1228, E-mail: jawkim96@yonsei.ac.kr

Received 4 March 2015 Revised 3 April 2015 Accepted 7 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.

Keywords: Tuberculosis, splenic, Gastrosplenic fistula, Granuloma

References

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Fig. 1.

CT images of chest and abdomen. (A) First chest scan shows two newly-developed 1.5-cm lobular consolidations in posterior segment of right upper lung and anterior segment of left upper lung. (B) Chest scan after one month of antibiotics shows mild improvement of initial chest lesion, but newly developed focal consolidation lesion on right lower lobe. (C) Final chest scan after six months of antituberculous treatment shows disappearance of focal consolidation on both upper lobe and right lower lobe. (D) First abdominal scan shows multiple focal hypodense lesions in spleen with cystic lesion on splenic hilum. (E) Abdominal scan after one month of antibiotics shows enlargement of multiple hypodense lesions on spleen. (F) Final abdominal CT scan after twelve months of antituberculous treatment shows splenic abscesses nearly healed.

Fig. 2.

Sonographic and fluoroscopic images. (A) Abdominal ultrasonography shows multiple low echoic nodules in spleen. (B) When dye was injected through ulceration site using gastroscope under fluoroscopic guidance, there was a fistular tract between the stomach and spleen.

Fig. 3.

Endoscopic findings. (A) Initial gastroscopy shows creamy yellowish discharge on ulceration of subepithelial mass from fundus to upper body, similar to an abscess. (B) After two months of antitubercular therapy, follow-up gastroscopy shows gastro-splenic fistular tract sealed off.

Fig. 4.

Microscopic finding of spleen biopsy specimen shows well-defined granuloma with epithelial cells and central caseous necrosis (H&E, ×100). Finding is compatible with chronic granulomatous inflammation with caseous necrosis, suggestive of tuberculosis.

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