extremely enlarged spleen, any treatments?


Dr. Young,

My very best friend is positive, and is now considered to have full blown AIDS. He was recently in the hospital because he could not control high fever and was unable to eat full meals. His lymph nodes have also been swollen on and off for months now, but have not reduced in size for qutite a while. The medical team assisting him has determined that his spleen is 4-5x the normal size, and his belly is extremely swollen. They removed one of his lymph nodes from his arm pit and have determined that he does not have any form of cancer. But, they have not told him what is causing the fever or the swelling in his spleen and lymph nodes. They also have opted not to remove his spleen. Is this dangerous? Are there any treatments that can reduce the swelling? If not, should they remove it if it continues to grow? I apologize for the length of my question. He lives in a small Texas town, and I worry that the medical advice that he is given may not be the best. It seems to him, and me as well, that they are far too vague. Thank you for your time.


Thanks for your question and comments.

Splenomegaly or enlarged spleen is a relatively common finding among persons with HIV infection. There are many causes of splenomegaly, including HIV itself.

Having a large spleen is really only dangerous if it reaches enourmous proportions, in these circumstances, there is a chance for rupture in the event of trauma. In only the most severe cases do we typically recommend splenectomy. If this were entertained, it would be very important to have your friend receive immunizations for pneumococcus and Hemophilus influenza prior to the surgery, if possible.

If HIV is the cause of splenic enlargement, the best course of action is effective therapy for HIV. You have not mentioned anything about your friends treatment situation, but I trust that this is one of the treatment approaches that is being used. The lack of finding cancer is, of course, reassuring. Some might suggest bone marrow biopsy as an alternative means of looking for a reason for splenomegaly.

Other potential causes of spleen enlargment include liver diseases, M. avium (MAC or MAI) infection, or other unusual infections, such as malaria (I doubt that this is a concern). MAC infection can be diagnosed by blood culture, or more rapidly by bone marrow biopsy.

I hope this helps, BY.