Fulminant hepatic failure caused by tuberculosis.

Abstract

A 54 year old Asian woman developed fulminant hepatic failure followed by renal failure. Because of a past history of possible tuberculosis, she was given antituberculous drugs. The chest x ray was normal. A transiugular liver biopsy showed caseating necrosis, granulomas, and acid fast bacilli indicative of miliary tuberculosis. Despite full supportive therapy, her condition deteriorated and she died. Postmortem examination showed widespread miliary tuberculosis; culture confirmed the presence ofMycobacterium tuberculosis. Tuberculosis causes fulminant hepatic failure rarely and only three cases have been described. In this, as with the other cases, hyponatraemia and hepatomegaly were features at presentation. This is the first report of treatment being given before death. (Gut 1995; 36: 792-794)

Localized Hepatic Tuberculosis with Imaging Changes Caused by the Progression of Tuberculosis

“…Hepatic TB is classified into three forms: miliary, diffuse and localized hepatic (10)(11)(12)(13). The miliary form is common, whereas the localized hepatic form is rare.…”

Portal Hypertension Secondary to Isolated Liver Tuberculosis

“…2 Therefore, hepatic involvement is possibly under-diagnosed and under-reported in clinical practice. Hepatic TB can be broadly divided into two types: the more common miliary type and the less common local type, each of which can be further divided into diffuse and nodular sub-types.…”

“…6 Tuberculosis is a known cause of portal hypertension with many reported cases in the literature. 2,[7][8][9][10][11][12][13][14][15][16] Tuberculosis can cause portal hypertension by direct involvement of the splenic hilum by fibrotic bands, which can lead to splenic venous occlusion, 13 indirect involvement of the splenic drainage by involving organs adjacent to the spleen such as a pancreatic mass mimicking carcinoma, 15 direct involvement of the abdominal vascular, 12 occurrence of acute hepatic failure, 2,13 and finally involvement of the liver along with its portal vein by micro and macro nodules/granulomas that can mimic cholangiocarcinoma. [8][9][10][11]14,16 The differential diagnosis of non-cirrhotic portal hypertension is broad.…”

Unusual Presentation of Tubercular Liver Abscess in an Immune-Competent Adult

“…The miliary type is the most common form that occurs in 50-80% of the patients with generalized miliary TB. 1 The granulomatous type is the second most common and can present with prolonged fever and mild jaundice, with or without hepatomegaly. The isolated hepatobiliary form has been uncommonly described with or without biliary involvement and accounts for less than 1% of all tubercular infections.…”