Tropical Splenomegaly Syndrome in a pregnant woman: A good response and prognosis to splenectomy

Abstract

The tropical splenomegaly syndrome (TSS) is characterized by massive splenomegaly with hypersplenism, moderate hepatomegaly, and lymphocytic infiltration of the hepatic sinusoids. TSS is restricted to native residents of and visitors to the “malaria belt,” which roughly encompasses equatorial regions of South America, Africa, the Middle East, South Asia, and Southeast Asia. A 24 years old female patient gravida II and para I with gestational age 24 weeks from south west of Eritrea (Shelallo) Gash Barka presented with dizziness, general body weakness, and abdominal discomfort for 3 weeks and left upper quadrant swelling of three years duration. Other associate symptoms were palpitation and dyspnea. She had history of repeated malaria attack. Physical examination revealed massive hepatosplenomegaly and pallor. Hematological studies revealed that severe anemia Hgb 3.8 g/dL, WBC 2.2× 103/mm3, MCV 97.6fl. Platelet 30×103/mm3, and reticulocyte count was 7%. Peripheral smear examination revealed normocytic normochromic red blood cells. Bone marrow examination revealed marked erythroid hyperplasia without sign of malignancy and left shift. The patient received 11 units of blood preoperative but, no improvement Hb remaining 3.7g/dl. Elective splenectomy was done. Intra-operatively and postoperatively she received an additional 5 units of blood. There was no postoperative complication. The patient was discharged with Hb of 6.0g/dl with slight improvement. The response to splenectomy was good. Four months postoperative and 40 days post delivery Hbg 16.3g/dl and platelet 254,000/mm and WBC 5000/ mm3. The outcome and prognosis of splenectomy in this patient was satisfactory.