Abstract
This case report presents a rare instance of concomitant splenic tuberculosis (TB), Epstein-Barr virus (EBV)-related T-cell leukemia/lymphoma, and malaria in a 28-year-old pregnant woman at a Médecins Sans Frontières-supported hospital in South Sudan. The patient was admitted with splenomegaly, anorexia, weakness, and transfusion-refractory anemia. She tested positive for malaria and was treated appropriately. Because of ongoing consumptive anemia, cachexia, and weakness severely impacting her quality of life, the patient underwent splenectomy. A diagnosis of TB was ultimately confirmed post-splenectomy through histopathological analysis and molecular testing. Gross findings from the pathologic analysis of a splenic sample revealed miliary deposits, necrotizing granulomas, and atypical lymphocytic infiltrates consistent with TB and EBV-associated leukemia/lymphoma. Despite temporary improvement post-operatively and the initiation of TB therapy, the patient discontinued treatment and was lost to follow-up, likely resulting in mortality. This report presents an unusual combination of concomitant pathologies that underscore the diagnostic challenges and complexity of managing overlapping infectious and hematological disorders in resource-limited settings.
Overview
- The study presents a rare case of a 28-year-old pregnant woman in South Sudan with concomitant splenic tuberculosis (TB), Epstein-Barr virus (EBV)-related T-cell leukemia/lymphoma, and malaria.
- The patient was admitted with symptoms of splenomegaly, anorexia, weakness, and transfusion-refractory anemia, and was treated for malaria.
- A diagnosis of TB was confirmed post-splenectomy through histopathological analysis and molecular testing, and the patient was started on TB therapy, but discontinued treatment and was lost to follow-up, likely resulting in mortality.
Comparative Analysis & Findings
- The study presents a rare combination of concomitant pathologies, including TB, EBV-related T-cell leukemia/lymphoma, and malaria, which underscores the diagnostic challenges and complexity of managing overlapping infectious and hematological disorders in resource-limited settings.
- The patient's symptoms were initially attributed to malaria, and treatment was initiated without considering the possibility of concomitant TB or leukemia/lymphoma.
- The diagnosis of TB and leukemia/lymphoma was only made possible through histopathological analysis and molecular testing post-splenectomy, highlighting the importance of comprehensive diagnostic workup in resource-limited settings.
Implications and Future Directions
- The study highlights the need for healthcare providers in resource-limited settings to remain vigilant for the possibility of concomitant infections and hematological disorders, and to consider a comprehensive diagnostic workup in the event of unexplained symptoms.
- Further research is needed to better understand the epidemiology and clinical presentation of concomitant TB and hematological disorders in resource-limited settings, and to develop effective diagnostic and treatment strategies.
- The study also underscores the importance of improving access to diagnostic tests and treatments for infectious diseases, particularly in resource-limited settings where the diagnosis and treatment of concomitant infections can be particularly challenging.