A 24-year-old man, injection drug user (IDU) and HIV-positive was admitted to the Infectious Department of Imam Khomeini Hospital in February 2010, with a history of two months of malaise, night sweating and weight loss. He complained of feverand chills. On examination, pale conjunctivae and a palpable spleen were the only remarkable clinical findings. PPD skin test was not reactive and chest X-ray was also normal. Abdominal CT scan revealed multiple hypodense regions suggestive forsplenic abscesses. Diagnostic laparatomy and splenectomy were performed. Definite tuberculosis infection became evident after that Ziehl- Neelsen staining of the inflammated tissue was performed and suspected acid-fast bacilli of Mycobacteriumtuberculosis were detected under microscopy. Consecutively, the tuberculostatic treatment including isoniazid (300 mg daily), rifampicin (600 mgr daily), ethambutol (800 mgr daily) and pyrazinamide (1000 mgr daily) were initiated; He eventually began to improve and the fever resolved within 10 days.
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