NDT Advance Access originally published online on July 22, 2006
Nephrology Dialysis Transplantation 2006 21(10):2994-2995; doi:10.1093/ndt/gfl205
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathological rupture of spleen in a haemodialysis patient due to tuberculosis
Email: dakshinamurty_kv{at}yahoo.comSir,
A traumatic rupture of the spleen has been described as a condition with grave consequences, if unrecognized and untreated. The spleen can get ruptured in the following circumstances: due to trauma to a diseased spleen; trauma to a normal spleen; spontaneous rupture of a diseased spleen (pathological rupture) and spontaneous rupture of a normal spleen (spontaneous rupture) [1,2].
The true incidence of pathological rupture is unknown. A Medline search confirmed that 352 cases were reported between 1966 and 2000 [3]. The causes were wide-ranging, from infective, haematological, metabolic, drug-induced to iatrogenic.
Tuberculosis as a cause of pathological spleen rupture has been described in a few case reports [3]. No case report has been reported of a haemodialysis patient. We report a 27-year-old male patient with a diagnosis of hypertension, end-stage renal disease, on maintenance haemodialysis from August 2005, who developed sudden onset of pain in the abdomen, vomiting, and shock following a session of haemodialysis, in which heparin was also given. He had no prior complaints of fever, night sweats, chill, weight loss or anorexia. There was no other organomegaly or lymphadenopathy. A plain radiograph of the abdomen showed opacification of the left half, with relative paucity of bowel loops, due to fluid collection in the left half of the abdomen. A CT scan showed the presence of peri-splenic haematoma and blood collection in the abdominal cavity. The chest radiograph was normal. An emergency splenectomy was done along with a blood transfusion, as about 1.5 l of blood was evacuated from the abdominal cavity. A histo-pathological examination showed the presence of granulomas with Langerhans giant cells (Figure 1). Ziehl–Neelsen staining did not reveal any acid-fast bacilli. He was discharged on anti-tuberculous therapy, and made a speedy recovery.
|
Oedema of the spleen may occur in uraemia [4]. The rupture appears to be precipitated by uraemic coagulopathy and the use of heparin, coupled with tuberculous infection. The tuberculous infection of the spleen has been reported in both immuno-competent and immuno-suppressed patients, albeit in the form of case reports [5]. It appears that there is no clear-cut way of diagnosing splenic tuberculosis other than a chance discovery on laparotomy and subsequent histopathological examination.
Conflict of interest statement. None declared.
Department of Nephrology
Nizam's Institute of
Medical Sciences
Hyderabad, India
References
- Hyun BH, Varga CF, Rubin RJ. (1972) Spontaneous and pathologic rupture of the spleen. Arch Surg 104:652–657.
[Abstract/Free Full Text] - Nicoll JA. (1968) Splenic haematoma after spontaneous rupture of the spleen. Am J Surg 116:117–119.[CrossRef][Web of Science][Medline]
- Debnath D and Valerio D. (2002) Atraumatic rupture of the spleen in adults. J R Coll Surg Edinb 47:437–445.[Web of Science][Medline]
- Zbrog Z and Pawlicki L. (1989) Spontaneous rupture of the spleen as a cause of death of a patient with uremia. Pol Tyg Lek 44:232–233.[Medline]
- Menakuru SR, Singh R, Sharma N, Verma S. (2005) Isolated splenic TB report of three cases. Trop Doct 35:246–267.
[Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||