Pyo pneumothorax revealing splenic tuberculosis abscess in a COVID-19 femmal: A case report

Introduction: Splenic tuberculosis (ST) is an uncommon entity, especially in an immunocompetent patient. Therefore, diagnosis delays may be seen and can lead to fatal complications. Presentation of case: We report a 37-year-old female with no medical history who presented to the emergency with a spontaneous left pyo pneumothorax. Reverse transcription-PCR analysis of COVID-19 was positive. Chest and abdominal Computed Tomography showed a ruptured splenic abscess with left pyopneumothorax. The diagnosis of splenic abscess with pleural fistulization was strongly suspected. Emergency surgery was decided for both therapeutic and diagnostic purposes. A left video thoracoscopy and splenectomy was performed. After histopathological examination, the diagnosis of ST ruptured in the pleural cavity was confirmed. The patient had a stable recovery and completed a 9-months regimen of anti-tuberculosis medications. Discussion: ST has no characteristic symptoms and diagnosis may be delayed until life-threatening complications arise. Pyopneumoyhorax complicating ST is an exceptional evolution and rarely reported in the literature. In this case, the authors reported a ST discovered following respiratory signs related to an intrapleural splenic rupture in a young woman co-infection with COVID-19. Conclusion: ST is extremely rare and has no characteristic symptoms. The evolution is unpredictable and can lead to splenic rupture. This rupture can be intrathoracic making the diagnosis more difficult.