50 2013 Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report Porpora trombocitopenica idiopatica associata a tubercolosi splenica: un caso clinic Mehmet Sinan Dal 1 , Tuba Dal 2 , Recep Tekin 3 , Erdal Bodakçi 1 , Yakup Düzköprü 1 , Mehmet Orhan Ayyildiz 1 1 Department of Hematology; 2 Department of Microbiology and Clinical Microbiology; 3 Department of Infectious Diseases and Clinical Microbiology, Dicle University, Diyarbakir, Turkey n INTRODUCTION T uberculosis is a major health problem in developing countries because of the in- creasing prevalence of immunocompro- mised patients and human immunodeficiency virus (HIV) infections [1, 2]. The first lesion of tuberculosis develops in the lung and then in the regional lymph node. Sometimes bacilli spread through blood and lymphatic circula- tion to multiple distant organs. This picture is known as miliary tuberculosis. In the large majority of tuberculosis cases the development of immunological reaction in- hibits the growth of mycobacteria in all infected sites and granulomas are formed. Granulomas are composed of epithelioid cells and giant cells, and surround and limit the foci of caseous necrosis which contains disintegrated cells and tuberculosis bacilli. Some bacilli located within granuloma may survive for a very long time and reactivate in favourable circumstances. Extrapulmonary tuberculosis accounts for 5- 50% of all tuberculosis cases. In humans with reduced immune function, in young children with immature immune systems and in the el- derly people with poor immune system func- tioning, and in patients with HIV infection and kidney failure, extra pulmonary tuberculosis is encountered more common [3-6]. Abdominal tuberculosis is one of the common presenta- tions of extrapulmonary tuberculosis and af- fects the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, pan- creas and spleen. Diagnosis of extrapulmonary tuberculosis is of- ten delayed due to a lack of specific symptoms. Therefore laboratory findings and radiologic detection are important for diagnosis. Abdomi- nal tuberculosis often shares manifestations with lymphoproliferative disease, inflammato- ry bowel disease, tumorous conditions or other infectious diseases [1, 7-9]. Isolated splenic tuberculosis is a rare form of abdominal tuberculosis. Splenic tuberculosis generally develops secondary to miliary tuber- culosis. Isolated splenic tuberculosis has no characteristic symptoms or abnormal imaging findings. It can be misdiagnosed as carcinoma of the spleen, splenic abscess, lymphoma, rheumatic fever or other diseases. The misdiagnosis rate is high if there is no history of tuberculosis in oth- er organs [1, 10]. In addition, many haematological abnormali- ties, such as pancytopenia, anaemia and leuko- cytosis, may be associated with tuberculosis. Thrombocytopenia is frequently caused by a Caso clinico Case report Le Infezioni in Medicina, n. 1, 50-55, 2013 *Corresponding author Tuba Dal E-mail: tuba_dal@yahoo.com