Isolated Hepatic Tuberculosis: Two Different Clinical Entities

Abstract

The diagnosis of tuberculosis is elusive because of its insidious nature and distinct clinical presentations. Isolated hepatic tuberculosis is a rare clinical entity among patients with tuberculosis. A 45 years old man was presented with complaints of upper abdominal pain, nausea and vomiting. Proteinuria induced by amyloidosis secondary to isolated hepatic tuberculosis was detected in routine urinalysis. Hepatic tuberculosis diagnosis was established by positive tuberculosis polymerase chain reaction from the liver tissue. A 27 years old man admitted to our hospital with a 2 months history of upper abdominal pain. The patient diagnosis was portal hypertension due to isolated hepatic tuberculosis. Both patients were followed up for 18 months under anti-tuberculosis treatment. Tuberculosis must be suspected in patients with liver mass in imaging studies and should be considered in the differential diagnoses that live in endemic areas for tuberculosis.

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

“…[ 16 ] A tuberculin skin test, which is typically positive, and PCR have a sensitivity and specificity of 58% and 96%, respectively, and when used in combination improve the rate of detection. [ 9 , 16 ] In the event of isolated elevation of alkaline phosphatase, the possibility of tubercular hepatic parenchymal involvement must be excluded. [ 17 – 19 ] In our case, the patient had no clinical symptoms and the laboratory tests for blood and liver function were normal.…”

“…[ 4 ] It may be misdiagnosed as a liver tumor, such as intrahepatic carcinoma or metastasis, or other lesions, such as liver abscess or hydatid cyst and so on. [ 5 – 9 ] Here, we report a case of isolated hepatic TB with primary misdiagnosis as small hepatocellular carcinoma (HCC) on contrast-enhanced ultrasonography (US) and magnetic resonance imaging (MRI). To our knowledge, similar cases have not been of such a small size.…”