The Unexpected Diagnosis of Hepatic Tuberculosis in an Immunocompetent Patient

Abstract

Background/Aim. Tuberculosis (TB) is a chronic infectious disease which affects millions. The most affected system is the respiratory. Thus, hepatic TB (HTB) without involvement of other organs is not common. Its clinical manifestations are not specific, and both imaging and histopathological findings are necessary for the diagnosis. The differential diagnosis includes primary and metastatic liver malignancies. Our aim is to describe the rare entity of HTB via a case presentation. Patient and Methods. We report a case of a 50-year-old female with abdominal pain, weight loss, fever, and anorexia. All imaging methods described a liver lesion. She underwent right lobe hepatectomy, and the histological evaluation demonstrated granuloma with central caseous necrosis. Results. Seven months postoperatively, the patient remains fit and healthy. Conclusion. HTB is a rare entity with no specific symptoms, signs, and no laboratory nor imaging findings. It can be managed effectively if diagnosed in time or lead to death if left untreated.

Hepatic Tuberculosis Manifested as Hepatic Abscess: A Report of a Unique Case

“…The patient showed each of the aforementioned characteristics. Young adults are the most commonly affected age group, although this condition can affect individuals of almost any age [ 5 , 6 ].…”

“…It coalesced with a similar sub-centimetric-sized lesion just inferior to it, most likely suggestive of a liquefied hepatic abscess (Figures 1A-1B). We noted multiple enlarged centrally necrotic discrete and few coalescing lymph nodes at the splenic hilum, porta hepatis, upper abdomen, and retroperitoneum, along bilateral iliac vessels, bilateral obturator region, and bilateral inguinal region (Figures 2, 3,4,5,6). Findings suggested an infectious disease.…”

Isolated hepatic tuberculosis in a middle aged diabetic lady: a rare case report

“…The granulomas are usually located near the portal tract and there is only mild impairment of hepatic function, so most of these lesions are minimally symptomatic or asymptomatic. [5][6][7] The most frequently encountered clinical and laboratory findings described in literature are fever, weight loss, abdominal pain, hepatomegaly and elevated alkaline phosphatase level. In our case report, the patient presented with prolonged fever with hepatomegaly and elevated alkaline phosphatase and ã-glutamyltransferase.…”

“…Pyrexia of unknown origin (PUO) a common presenting feature. [6][7][8] Liver biopsy is essential in cases where clinical and imaging features are equivocal and should not be delayed, even when there are other recognizable etiological factors of liver disease. 9,10 Anti-TB treatment is effective and the prognosis is usually good in most cases with early diagnosis and treatment.…”

Clinical Manifestations, Imaging Features, and Treatment Follow-Up of 29 Cases With Hepatic Tuberculosis

“…Statistically, HTB accounts for 1.5%–4.2% of digestive system diseases manifested by fever and approximately 2.7% of active TB autopsies. 9 Garmpis et al 10 found that HTB was characterized by central caseous necrotic granuloma with or without anti-acid bacteria, indicating that a liver biopsy of suspected cases of HTB may be useful for the timely diagnosis and treatment of the disease. A study conducted by Freitas et al 11 also indicated the important role of a liver biopsy in correctly diagnosing HTB in patients with significant liver injury factors but atypical clinical manifestations.…”