Suspected Case of Secondary Splenic Tuberculosis Difficult to Differentiate from Pyogenic Splenic Abscess

Splenic tuberculosis is known to occur due to hematogenous spread from the affected lungs. Ultrasonography shows non-specific features, including hepatosplenomegaly or abscess. Possible small hypoechoic nodules or larger hypoechoic mass-like areas are also observed. Sometimes it is challenging to differentiate splenic tuberculosis from a splenic pyogenic abscess. An 85-year-old man visited our clinic with abdominal discomfort and fatigue. He had a history of antituberculous medication. Upper abdominal ultrasonography showed an about 5 cm-sized pyogenic abscess-like lesion in the spleen. His symptoms and laboratory findings were not improved after a course of empirical antibiotic treatment. He was suspected of having secondary splenic tuberculosis and continued taking antituberculous medication. We are following up on his symptoms and radiologic images.