Spontaneous splenic rupture: a sporadic presentation of tuberculosis—a case report

Atraumatic or spontaneous splenic rupture is a rare but life-threatening emergency. Common causes include hematologic malignancies and infections, but tuberculous involvement of the spleen is exceedingly uncommon. To our knowledge, this represents the third reported case of spontaneous rupture of a tuberculous spleen. We report a 50-year-old human immunodeficiency virus (HIV) -positive woman who presented with cough, fever, and abdominal distension, with abdominal examination suggesting peritoneal irritation and laboratory tests showing severe anemia. Emergency laparotomy revealed a ruptured spleen with 500 ml of hemolyzed blood, and splenectomy was performed. Histopathology confirmed splenic tuberculosis. The postoperative course was uneventful. Splenic tuberculosis typically occurs in disseminated disease among immunocompromised individuals. Fever of unknown origin is the commonest presentation; spontaneous rupture is exceptionally rare and difficult to diagnose. Although antitubercular therapy is the mainstay of treatment, hemodynamically unstable patients require surgery. Spontaneous splenic rupture should be considered in immunocompromised patients with an acute abdomen, as early recognition is lifesaving.