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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 14
| Issue : 4 | Page : 208 |
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Tuberculous splenic abscess in non-human immunodeficiency virus patient
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| Date of Submission | 26-Jun-2021 |
| Date of Decision | 10-Aug-2021 |
| Date of Acceptance | 20-Sep-2021 |
| Date of Web Publication | 11-Jan-2022 |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P.O.Box 55302, Baghdad Post Office, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/hmj.hmj_36_21
How to cite this article:
Al-Mendalawi MD. Tuberculous splenic abscess in non-human immunodeficiency virus patient. Hamdan Med J 2021;14:208 |
Dear Editor,
I read with interest the case report by Juneja and Jhamb[1] published in the April-June 2021 issue of the Hamdan Medical Journal. They reported a case of tuberculous splenic abscess in a non-human immunodeficiency virus (HIV) female patient, aged 22 years, from India. It is well-known that due to a compromised immune status, HIV-infected patients are venerable to different types of infections, including tuberculosis (TB). Extrapulmonary TB is not uncommon among such patients. Interestingly, splenic lesions were detected with ultrasonography in 21% of HIV-positive patients and TB diagnosed by smear, biopsy, culture or molecular methods was reported to be the cause of 88.3% of splenic microabscesses found on ultrasonography in such patients.[2] India is among Asian countries importantly affected by HIV and TB infections. The available data pointed out that among TB patients in India, 12% were HIV-positive, and of these, 40% were newly diagnosed.[3] Claiming the immunocompetent status in the case in question based on the negative enzyme-linked immunosorbent assay (ELIZA) as Juneja and Jhamb[1] stated is questionable. The 4th-generation combining HIV antibody and p24 antigen test could better detect early HIV infection. It has a sensitivity and specificity of 100% and 97.8%, respectively.[4] I presume that TB should be considered seriously in the studied patient. Juneja and Jhamb[1] ought to in-depth evaluate the HIV status in their studied patient by employing a more advanced diagnostic tool such as the above-mentioned test rather than solely relying upon ELIZA. Documenting HIV positivity in the case in question would make it the second case report of HIV-associated TB splenic abscess in the Indian literature. The first case was reported in a 40-year-old female.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Juneja A, Jhamb R. Tuberculous splenic abscess in non-human immunodeficiency virus patient. Hamdan Med J 2021;14:104-5.  [Full text] |
| 2. | Schafer JM, Welwarth J, Novack V, Balk D, Beals T, Naraghi L, et al. Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV: A systematic review. S Afr Med J 2019;109:570-6. |
| 3. | Kumar AM, Gupta D, Kumar A, Gupta RS, Kanchar A, Rao R, et al. HIV testing among patients with presumptive tuberculosis: How do we implement in a routine programmatic setting? Results of a large operational research from India. PLoS One 2016;11:e0156487. |
| 4. | Han H, Huang Y, Dong Q, Huang Y, Lu J, Wang W, et al. Clinical application evaluation of a fourth-generation HIV antigen antibody combination screening assay. Clin Lab 2019;65. [doi: 10.7754/Clin.Lab. 2019.190220]. |
| 5. | Jadhav SV, Vyawahare CR, Chaudhari N, Gupta NS, Gandham NR, Misra RN. Primary splenic tubercular abscess in an immunocompromised patient-rapid diagnosis by line probe assay. J Clin Diagn Res 2013;7:1996-8. |
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