Hepatic tuberculoma: A challenging diagnosis

Abstract

Clinical case presentationWe present the case of a 32-year-old Tunisian woman living in Belgium with a 5-year history of liver lesions. Her medical history is marked by two pregnancies, and pleural tuberculosis at the age of 23, treated by antitubercular agents. The lesions were incidentally discovered in 2013 on a CT scan during a workout because of postpartum fever. They measured 8, 28, and 11 mm, respectively, at segments 7, 5, and 6; based on both MRI and ultrasound, they were considered atypical. She was asymptomatic and put under surveillance with no precise diagnosis.An MRI in 2016, eight months after giving birth to her second child, showed no growth of the subcapsular lesions, however a change in signal intensity was noted for one of the lesions (Figure 1). This information, combined with her medical history of right pleural tuberculosis, led us to do an interferon-gamma release assay, that was positive. FDG-uptake on a complementary PET-CT was observed for the lesion at segment 6 (Figure 2). Laparoscopic resection was performed (Figure 3). The resection specimen consisted of a 2 cm cheesy white nodule with a fibrous cap (Figure 4). Histology revealed a caseating granuloma, with positive staining for acid-fast bacilli and a positive PCR for Mycobacterium tuberculosis (Figure 5). A diagnosis of hepatic tuberculoma was made, and quadruple antituberculous treatment was started.