Tuberculosis Esplenica
Masculino 31 años edad con antecedentes personales remotos de estrechez uretral ( desde niño ) que a pesar de ser operada, no resultó exitosa, debido a lo cual desarrolló daño renal que terminó con insuficiencia renal crónica (IRC). Hace 9 años que está en tratamiento de diálisis renal y hace 7 años le fue trasplantado un riñón, esto se convirtió en un fracaso porque el paciente durante el tratamiento de inmunosupresión desarrolló tuberculosis pulmonar y el trasplante renal fracasó, siendo dejado el riñón trasplantado ´in situ´ un hecho inédito para este autor, al parecer el paciente ha rechazado someterse a una nueva cirugía para extraer el riñón trasplantado.El paciente viene por fiebres altas ( 39-40 ° C),astenia, sudoraciones profusas, perdida de peso e intenso dolor en costado izquierdo que le dificultan la movilidad. El examen sonografico abdominal muestra presencia de riñón trasplantado con marcada hipoecogenicidad y distorsión de sus elementos sin poderse diferenciar el cortex de la médula renal. El hígado luce aumentado de tamaño al igual que el Bazo, este ultimo muestra un volumen aprox: de 656,23 ml ( hepatoesplenomegalia). En el bazo se visualiza imagen nodular, sólida , con reborde anecogénico y con presencia de microcalcificaciones internas, mide aprox:3,43 X 3,55 X 2,82 cm.El Doppler Color no muestra aumento del flujo vascular dentro del nodulo y la Elastografia presenta un patrón con Score 2 en la escala de Ueno, lo cual lo clasifica como presumiblemente benigno. La radiografía de torax mostró un enfisema pulmonar y cierto grado moderado de cardiomegalia. Se concluye con el diagnóstico de Tuberculosis Esplenica en paciente con riñón trasplantado. Esta programado para biopsia hepática por el gastroenterologo.
A 31-year-old male with a remote family history of the urethral stricture (from a child) who, despite being operated on, was unsuccessful, resulting in kidney damage that ended with chronic renal failure (CRF) 9 years ago Renal dialysis and 7 years ago a kidney was transplanted, this became a failure because the patient during the treatment of immunosuppression developed pulmonary tuberculosis and renal transplantation failed, leaving the kidney transplanted 'in situ' a fact unheard of for this Author, apparently the patient has refused to undergo further surgery to remove the transplanted kidney. The patient comes from high fevers (39-40 ° C), asthenia, profuse sweating, weight loss, and intense pain on the left side that make it difficult to mobility. The abdominal sonographic examination shows the presence of a transplanted kidney with marked hypoechogenicity and distortion of its elements without being able to differentiate the cortex from the renal medulla. The liver appears enlarged in size, as does the spleen, which shows a volume of approximately 656.23 ml (hepatosplenomegaly). In the spleen, we can see a solid nodular image with anechoic ridge and with the presence of internal microcalcifications, which measures approx: 3.43 X 3.55 X 2.82 cm. Color Doppler does not show increased vascular flow within the nodule and the Elastography presents a pattern with Score 2 on the Ueno scale, which classifies it as presumably benign. The chest X-ray showed pilular emphysema and a moderate degree of cardiomegaly. It concludes with the diagnosis of Splenic Tuberculosis in a patient with a transplanted kidney. It is programmed for liver biopsy by the gastroenterologist.
Splenic Tuberculosis
A 31-year-old male with a remote family history of the urethral stricture (from a child) who, despite being operated on, was unsuccessful, resulting in kidney damage that ended with chronic renal failure (CRF) 9 years ago Renal dialysis and 7 years ago a kidney was transplanted, this became a failure because the patient during the treatment of immunosuppression developed pulmonary tuberculosis and renal transplantation failed, leaving the kidney transplanted 'in situ' a fact unheard of for this Author, apparently the patient has refused to undergo further surgery to remove the transplanted kidney. The patient comes from high fevers (39-40 ° C), asthenia, profuse sweating, weight loss, and intense pain on the left side that make it difficult to mobility. The abdominal sonographic examination shows the presence of a transplanted kidney with marked hypoechogenicity and distortion of its elements without being able to differentiate the cortex from the renal medulla. The liver appears enlarged in size, as does the spleen, which shows a volume of approximately 656.23 ml (hepatosplenomegaly). In the spleen, we can see a solid nodular image with anechoic ridge and with the presence of internal microcalcifications, which measures approx: 3.43 X 3.55 X 2.82 cm. Color Doppler does not show increased vascular flow within the nodule and the Elastography presents a pattern with Score 2 on the Ueno scale, which classifies it as presumably benign. The chest X-ray showed pilular emphysema and a moderate degree of cardiomegaly. It concludes with the diagnosis of Splenic Tuberculosis in a patient with a transplanted kidney. It is programmed for liver biopsy by the gastroenterologist.
