Rare and unusual case of hepatic and disseminated tuberculosis in an immunocompetent patient

Abstract

Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.

Disseminated Hematogenous Tuberculosis after Spontaneous Abortion

“…In 2011, there were estimated to be more than 200,000 cases of active TB in pregnant females across the globe [2]. Tuberculosis is a common cause of both maternal and fetal morbidity with the majority of cases being pulmonary tuberculosis.…”

“…Disseminated tuberculosis (TB) is a life-threatening mycobacterial infection that either involves the blood, bone marrow, liver, or two or more noncontiguous sites [1]. The diagnosis can be difficult to make as symptoms can vary significantly and often mimic other pathologies [2], [3]. Disseminated tuberculosis is associated with significant mortality and morbidity for both mother and fetus including a ninefold increase in miscarriage, and a six fold increase in perinatal death [4], [5].…”

“…Disseminated tuberculosis is associated with significant mortality and morbidity for both mother and fetus including a ninefold increase in miscarriage, and a six fold increase in perinatal death [4], [5]. The normal physiological immune suppression in pregnancy can potentially increase a patient's susceptibility of infection, reactivation and spread of tuberculosis primarily in the postpartum period [2]. Despite being rarely seen in pregnant or postpartum females, the mortality and morbidity of disseminated tuberculosis warrant prompt evaluation and treatment with high clinical suspicion [1].…”

A Case Report of Widely Disseminated Tuberculosis in Immunocompetent Adult Male

“…Despite previous reports of CNS dissemination of TB, this case stands to acknowledge the difficulty of diagnosis in the ED, and the need for emergency physicians (EP) to maintain a broad differential including disseminated TB as a possibility from the beginning of assessment. [8][9][10][11][12] In this case EPs should be aware of predisposing factors of disseminated TB in patients presenting with nonspecific symptoms. These predisposing factors include impaired cell-mediated immunity as seen in HIV/acquired immune deficiency syndrome patients, increased use of immunosuppressive drugs, diminished ability of the liver to clear bacteria from the bloodstream as seen in advanced liver disease among others, and recent immigration from areas with high rates of TB.…”

The Unexpected Diagnosis of Hepatic Tuberculosis in an Immunocompetent Patient

“…Several articles and case reports in the literature have described interesting cases of isolated hepatic TB or in association with disseminated disease [ 18 – 23 ]. However, only Eshiwe et al in 2019 [ 23 ] have clearly described hepatic involvement to such extent in an immunocompetent patient like in this case. More specifically, Abeysekera et al [ 18 ], Kayar et al [ 19 ], and Sharma et al [ 20 ] described rare cases of isolated hepatic TB in immunocompetent patients.…”