- A 29-year-old with history of perinatal HIV reported with night sweats and abdominal pain.
- Physical examination findings showed massive splenomegaly.
- Histopathological findings of the spleen were consistent with the diagnosis of mycobacterial spindle-cell pseudo-tumour.
A 29-year-old man reported to the hospital with drenching night sweats and abdominal pain. His medical history stated that he had acquired human immunodeficiency virus (HIV) perinatally/during childbirth. Similarly, he also had a history of adherence to antiretroviral therapy. However, the adherence was intermittent and on presentation, the CD4 count of the patient was 18 cells per cubic millimetre (reference range: 500 to 1500). Moreover, the viral load for HIV was not detectable.
Physical examination showed severe abdominal distension with diffuse abdominal tenderness and splenomegaly on palpation. For further evaluation, a computed tomography was performed which showed a massive splenomegaly with splenic parenchyma and multifocal infarction. The patient underwent a splenectomy with embolisation of the splenic artery.
Histopathological examination of the spleen showed near-total replacement of the splenic parenchyma by spindle-shaped appearance nodular aggregates and extensive necrosis. Acid fast staining showed aggregates of mycobacteria that had gone under phagocytosis by histiocytes.
The findings were consistent with the diagnosis of mycobacterial spindle-cell pseudo-tumour. Further blood cultures were obtained which showed growth of Mycobacterium avium–intracellulare complex. The patient was treated with clarithromycin, rifabutin and ethambutol. Moreover, he was later discharged with a plan to continue long-term antimycobacterial therapy.
References
Massoth, L. R., & Louissaint Jr, A. (2020). Massive Splenomegaly from Disseminated Mycobacterium avium–intracellulare Infection. The New England Journal of Medicine, 382(11), 1041-1041.
