Korean J Intern Med.  2013 Mar;28(2):187-196. 10.3904/kjim.2013.28.2.187.

Clinical characteristics and the usefulness of the QuantiFERON-TB Gold In-Tube test in hematologic patients with hepatic or splenic lesions

• Kwon JC
• Kim SH
• Park SH
• Choi SM
• Lee DG
• Choi JH
• Yoo JH
• Kim YJ
• Lee S
• Kim HJ
• Cho SG
• Lee JW
• Min WS

• KMID: 1501774
• DOI: http://doi.org/10.3904/kjim.2013.28.2.187

Abstract

BACKGROUND/AIMS
Hepatic or splenic lesions in hematologic patients are not defined well because they are not easy to evaluate due to limitations of invasive procedures. Management typically depends on the clinical diagnosis with few microbiological data.
METHODS
We reviewed the medical records of consecutive hematologic patients with hepatic or splenic lesions in the infectious diseases unit from April 2009 to December 2010 at the Catholic Hematopoietic Stem Cell Transplantation Center in Korea.
RESULTS
Twenty-six patients were identified. Their mean age was 46.0 +/- 14.7 years, and 16 (61.5%) were male. Underlying diseases were acute myelogenous leukemia (n = 15, 57.7%) and myelodysplastic syndrome (n = 6, 23.1%). Among the nine nontuberculous infectious lesions, two bacterial, six fungal, and one combined infection were identified. The numbers of confirmed, probable, and possible tuberculosis (TB) cases were one, three, and four, respectively. Two patients had concurrent pulmonary TB. QuantiFERON-TB Gold In-Tube (QFT-GIT, Cellestis Ltd.) was positive in seven cases, among which six were diagnosed with TB. The sensitivity and specificity of QFT-GIT were 75% and 81.3%. Nine (34.6%) were defined as noninfectious causes.
CONCLUSIONS
Causes of hepatic or splenic lesion in hematologic patients were diverse including TB, non-TB organisms, and noninfectious origins. TB should be considered for patients not responding to antibacterial or antifungal drugs, even in the absence of direct microbiological evidence. QFT-GIT may be useful for a differential diagnosis of hepatosplenic lesions in hematologic patients.

Keyword

Hematology; Liver abscess; Tuberculosis; Diagnosis

MeSH Terms

Abscess/*diagnosis/microbiology/mortality/therapy
Adult
Anti-Infective Agents/therapeutic use
Chi-Square Distribution
Female
Hematologic Diseases/*complications/mortality
Humans
*Interferon-gamma Release Tests
Liver Abscess/*diagnosis/microbiology/mortality/therapy
Male
Middle Aged
Predictive Value of Tests
Prognosis
Republic of Korea
Retrospective Studies
Risk Factors
Splenic Diseases/*diagnosis/microbiology/mortality/therapy
Time Factors
Tuberculosis/*diagnosis/microbiology/mortality/therapy
Anti-Infective Agents