Abdominal
tuberculous lymphadenitis is very rare. We report a case of
pulmonary tuberculosis showing marked abdominal
lymphadenopathy and
splenomegaly. A 95-year-old man was admitted to our hospital because of abnormal chest X-ray and
body weight loss in last 6 months. He had low grade
fever with no
abdominal pain. He did not have past history of
tuberculosis. Laboratory examination showed mild renal dysfunction and mild
glucose intolerance. Soluble
interleukin 2 recepter was highly elevated (3800 U/ml).
Tumor markers, such as
carcinoembryonic antigen (CEA),
cytokeratin 19 fragment (CYFRA), and
progastrin-releasing
peptide (Pro GRP) were all within normal limit. Chest X-ray showed multiple nodules in bilateral lung fields. Chest computed tomography showed multiple nodules in bilateral lungs, especially in upper part of lungs, right hilar
lymphadenopathy and upper mediastinal
lymphadenopathy. Abdominal and pelvic enhanced computed tomography showed marked abdominal
lymphadenopathy and
splenomegaly (67 x 49 mm). Abdominal lymph nodes were hepatoduodenal (50
x 50 mm), splenic hilar (40 x 25 mm), upper paraaortic (30 x 60 mm), and small superior mesenteric (10 x 10 mm) lymph nodes. FDG-PET showed accumulation in the nodules of right lung field, right hilar lymph nodes, upper mediastinal lymph nodes, and abdominal lymph nodes. Bronchial lavage fluid (BAL) smear for
acid-fast bacilli was positive, polymerase chain reaction for Mycobacterium tuberculosis was positive and
acid-fast bacilli was cultured. Transbronchial lung biopsy specimen demonstrated non-specific intraalveolar organization and alveolitis. The patient was diagnosed as
pulmonary tuberculosis, but about abdominal
lymphadenopathy and
splenomegaly we had to differentiate
malignant lymphoma, and for definite diagnosis,
laparotomy was necessary. But considering his age and general condition, we followed up carefully with anti-
tuberculosis therapy.
Pulmonary tuberculosis, abdominal
lymphadenopathy and
splenomegaly all showed marked improvement 4 months after starting anti-
tuberculosis therapy with
isoniazid,
rifampicin, and
ethambutol, so we clinically diagnosed abdominal
tuberculous lymphadenitis and
splenic tuberculosis.