Presentation
Fever of unknown origin. History of HIV and tuberculosis, motor vehicle accident 10 years previously and colostomy 3 years ago.
Patient Data
Fatty liver.
Normal-sized spleen studded with many tiny hypodense nodules, some of which have a punctate hyperdense center that perhaps signifies central calcification.
Extensive abdominal wall atrophy.
Multiphasic CT chest-abdomen-pelvis:
Virtually all of the splenic nodules have calcified.
Case Discussion
History notable for HIV, tuberculosis of the bowel, and alcohol abuse.
Incidental numerous, tiny splenic nodules, some with a central hyperdense dot, seen on the first CT abdomen, done for workup of fever of unknown origin. A CT study from 2 years earlier was accessed, which showed that the nodules had already appeared then but had enlarged in the interval. An extensive blood panel yielded antibodies for strongyloides spp. The nodules, then, most probably represent infectious granulomas, due to either strongyliodiasis or tuberculosis.
A consecutive CT study done 1.5 years later, after the patient had tumbled down a flight of stairs, showed that virtually all of the nodules had calcified.
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