PUO – A rare (and forgotten) cause!

Splenic tuberculosis is an extremely rare clinical entity and a frequently forgotten cause of pyrexia of unknown origin (PUO). We present the case of a 42 year old man who presented with fever of unknown origin. Ultrasonography revealed multiple hypoechoic areas within the spleen. As the abscesses did not respond to broad spectrum antibiotics splenectomy was done. The excised organ showed multiple cysts filled with pultaceous material. Histopathological examination revealed areas of granular caseating necrosis surrounded by epitheloid cells and Langhan’s type giant cells consistent with splenic tuberculosis. There was no evidence of a primary focus in the lungs or in any other organ. The presence of isolated tubercular foci in the spleen without any evidence of tuberculosis in lung or other extra-pulmonary site prompted us to report this case.