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A 33-year-old woman was admitted for surgical drainage of a peri-anal abscess. No other significant problems were reported and her chest radiograph was normal. In spite of adequate surgical drainage, her swinging pyrexia continued. Ultrasound and abdominal computed tomography (CT) scan (figure 1) showed numerous ill-defined hypoechoic and hypodense lesions in the spleen.
Her HIV-test was positive. No other source for her fever was identified. Despite antituberculous treatment for 3 weeks the high fever continued. It was felt splenectomy was indicated.
The intra-abdominal findings were unremarkable except for a slightly enlarged spleen with a myriad of yellowish nodules protruding through the splenic capsule (figure 2). Histology confirmed tuberculosis of the spleen. Postoperatively the temperature returned to normal and the patient was discharged 5 days later on antituberculous treatment. Six months after the operation the patient is well.