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Vol. 19. Issue 6.
Pages 664-665 (November - December 2015)
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Vol. 19. Issue 6.
Pages 664-665 (November - December 2015)
Clinical image
DOI: 10.1016/j.bjid.2015.06.003
Open Access
A pathognomonic calcification pattern in chronic splenic brucellosis
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Ulysses S. Torresa,
Corresponding author
usantor@yahoo.com.br

Corresponding author at: Department of Radiology, Hospital São Luiz Fleury Medicina Diagnóstica, Rua Doutor Alceu de Campos Rodrigues, 95, Vila Nova Conceição, São Paulo 04544-000, Brazil.
, Luciana Vargas Cardosob, Giuseppe D’Ippolitoa,c
a Department of Radiology, Hospital São Luiz, Fleury Medicina Diagnóstica, Rio de Janeiro, RJ, Brazil
b Department of Radiology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
c Department of Imaging, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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A 75-year-old male farmer presented for an abdominal CT scan because of a nonspecific, longstanding abdominal discomfort, fatigue and appetite loss. Although there were no other remarkable imaging findings, an unusual pattern of multiple, thinly, concentrically lamellated calcifications resembling targets was found in the spleen (Fig. 1A), also characterized on a further MRI work-up (Fig. 1B). Such isolated radiological finding raised suspicion of brucellosis. Laboratory tests for tuberculosis, histoplasmosis, HIV, and echinococcosis were all negative. A diagnosis of isolated splenic brucelloma was made on the basis of a positive Brucella IgG ELISA test, clinical history, and imaging findings.

Fig. 1.

CT and MRI findings in a case of isolated chronic splenic brucelloma. Unenhanced CT (A) and fat-suppressed T2-weighted MR (B) images demonstrate multiple, thinly, target-like, concentrically lamellated calcifications in the spleen, a pattern considered characteristic for this diagnosis.

(0.16MB).

Hepatosplenic involvement is common during the course of acute brucellosis (up to 60% of patients) and usually manifests as hepatosplenomegaly or mild increase of hepatic enzyme levels secondary to a nonspecific or granulomatous hepatitis, with good prognosis.1 Chronic brucellar hepatosplenic abscesses (brucellomas) are rare (about 2% of cases), being considered true focal complications. Isolated brucellar splenic abscesses are even rarer, with only about 20 cases reported.2

Peripheral or central gross calcifications with a snowflake appearance are a common finding in hepatosplenic brucellomas (83–100% of cases),1 although absolutely nonspecific. Early radiograph descriptions, however, have reported on a characteristic concentrically lamellated pattern of splenic calcifications in chronic brucellosis,3 which unfortunately has not been demonstrated after the advent of CT,1 probably due to the rarity of splenic brucellomas and the much larger trend for an uncharacteristic gross appearance. Thus, to the best of our knowledge, this is the first report to demonstrate CT and MRI findings of this pathognomonic pattern of calcifications in splenic brucellomas since its earlier radiographic descriptions. Although exceedingly rare, awareness of this typical pattern may be useful for raising clinical suspicion, especially because diagnosis of chronic brucellosis may be sometimes misleading due to nonspecific clinical presentation.

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Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
J. Ariza, C. Pigrau, C. Cañas, et al.
Current understanding and management of chronic hepatosplenic suppurative brucellosis.
Clin Infect Dis, 32 (2001), pp. 1024-1033
[2]
M. Yilmaz, F. Arslan, O. Başkan, A. Mert.
Splenic abscess due to brucellosis: a case report and a review of the literature.
Int J Infect Dis, 20 (2014), pp. 68-70
[3]
J.P. Arcomano, N.F. Pizzolato, R. Singer, S.M. Zucker.
A unique type of calcification in chronic brucellosis.
AJR Am J Roentgenol, 128 (1977), pp. 135-137
Copyright © 2015. Elsevier Editora Ltda.. All rights reserved
The Brazilian Journal of Infectious Diseases

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