This was a 68-years old man who was treated for lung cancer. He had no local disease (top left figure). He started running fever and had weight loss.
A PET/CT showed new splenic lesions. The concern was of metastatic disease and a CT guided biopsy was performed. His INR and PT were absolutely normal. 10 cc of frank pus was aspirated, which was PCT positive for M. tuberculosis.
Two hours later he collapsed. A repeat CT scan showed hemorrhage. He was shifted to a hospital, where he did not improve and surgery showed significant hemorrhage. Splenectomy was done but he continued to deteriorate and finally passed away.
Accordingly to the hematologist, in rare situations, patients with known malignancies may have disordered coagulation despite a normal INR and PT. There is not much we can do to figure this issue out. However, it is a good idea to always approach splenic biopsies with caution and to never take them lightly.
#CTbiopsy #spleenbiopsy #tuberculosis #tuberculosisspleen