Presentation
Newly diagnosed with pulmonary tuberculosis and HIV. There is a background of fever, weight loss, and night sweats.
Patient Data
Abdominal and pelvic ultrasound confirms the presence of multiple, ill-defined, hypoechoic, splenic abscesses with the absence of splenomegaly.
There is no hepatomegaly and no intrahepatic abscesses.
There are diffusely echogenic kidneys bilaterally, with the noted absence of renal sinus fat and some perinephric fluid.
There are generalised subcentimetre mesenteric lymph nodes.
The rest of the viscera are normal.
There is no ascites and no basal effusions.
Case Discussion
The patient is newly diagnosed with HIV and active pulmonary tuberculosis. The ultrasound was requested to exclude abdominal tuberculosis.
In our HIV endemic setting, the presence of markedly echogenic, with a maintained or increased renal size is strongly suggestive of HIV-associated nephropathy (HIVAN), especially in a young, non-hypertensive, and non-diabetic patient. This is often histologically proven on numerous renal biopsies performed for confirmation in these patients.
There are multiple splenic abscesses, again strongly suggestive of abdominal/splenic tuberculosis. The broad DDX in these patients include:
idiopathic
bacterial, fungal, or parasitic abscesses
The presence of generalised cystic abdominal and pelvic lymph adenopathy is consistent with HIV and/or abdominal tuberculosis/ tuberculous lymphadenitis.