Clinical Diagnosis of Tuberculosis With Atypical Manifestations Involving the Liver and Spleen With Spontaneous Subscapular Hematoma in a Resource‐Limited Setting: A Case Report and Review of Literature

Abstract

Background: Isolated liver and spleen involvement of tuberculosis (TB) is a rare presentation. Case Presentation: A 60-year-old male patient from Bahir Dar City in the Amhara Region of Ethiopia presented with a 4-month history of low-grade fever, significant weight loss, drenching night sweats, poor appetite, exertional shortness of breath, and easy fatigability. Two weeks before his presentation, all symptoms worsened, and the patient started to experience left upper quadrant (LUQ) abdominal pain with a dragging sensation. Abdominal ultrasound showed hepatosplenomegaly with a linear hypoechoic area seen at the upper pole of the spleen, likely infarctions, and periportal lymphadenomegaly was visible. An abdominal CT scan showed a subcapsular hematoma on the upper pole of the spleen. After carefully ruling out both infectious and noninfectious differential diagnoses, we considered extrapulmonary tuberculosis and decided to initiate an antituberculosis trial. Extrapulmonary TB (hepatosplenic TB) was considered, and anti-TB medications were started. On his 6-month follow-up and evaluation, his symptoms were improved with normal physical findings and normal investigation findings. Conclusion: Even though isolated hepatosplenic TB is a rare condition, it has to be considered especially in low socioeconomic communities after excluding other alternative diagnoses.