A Case Report of Primary Hepatic Tuberculosis

This case report presents an incidental finding of primary tuberculosis in the liver of a 54-year-old female patient who had a history of multiple hospital admissions due to abdominal pain, jaundice, persistent fever, nausea with vomiting, weight loss, and asthenia. The evaluation involved considering differential diagnoses of cholangiocarcinoma, Caroli's disease, hepatocellular carcinoma, and hepatic tuberculosis based on the patient's history, imaging studies, and laboratory tests. The aim of this report is to provide healthcare professionals with a new diagnostic perspective when encountering patients with this ambiguous presentation, even in regions with low epidemiological incidence. Hepatic tuberculosis should be included in the differential diagnosis of patients with focal intrahepatic lesions or liver abscesses who have a history of recurrent hospitalizations and evidence on imaging studies.

Se trata de un hallazgo incidental de tuberculosis primaria en el hígado en una paciente femenina de 54 años con historia de múltiples ingresos por síntomas de dolor abdominal, ictericia, fiebre persistente, náuseas acompañadas de vómitos de contenido gástrico, pérdida de peso y astenia. A la evaluación se consideraron los diagnósticos diferenciales de colangiocarcinoma, enfermedad de Caroli, carcinoma hepatocelular y tuberculosis hepática, basados en anamnesis, estudios de imágenes y pruebas de gabinete. Este reporte de caso brinda una nueva perspectiva diagnóstica para el personal de salud que reciba pacientes con esta presentación ambigua, aun en el contexto de baja incidencia epidemiológica. La tuberculosis hepática debe ser considerada en el diagnóstico diferencial de pacientes con lesiones focales a nivel intrahepático o abscesos hepáticos con hospitalizaciones recurrentes y evidencia de imágenes.

Hepatic tuberculosis:one case report and literature review / 中国感染与化疗杂志

Objective To understand the clinical features of hepatic tuberculosis. Methods The clinical manifestations, laboratory findings, treatment, and prognosis of a case of hepatic tuberculosis were analyzed. Similar cases were identified from PubMed database during the period from 2013 to 2017 using search terms "Liver/Hepatology/Hepatic Tuberculosis". The clinical data of the identified patients with hepatic tuberculosis were reviewed and analyzed. Results The 16-year-old male patient presented with cough and abdominal distension. His sputum was positive for acid-fast bacillus. CT showed low-density spaceoccupying lesions. After anti-tuberculosis treatment, the lesion disappeared. Hepatic tuberculosis was finally considered, which was caused by disseminated tuberculosis. Literature search identified 63 similar cases. In summary, the 64 cases(containing this one)included 38 males and 26 females with age from 11 months to 77 years. Tuberculosis in other site or underlying disease was found in 39 cases. The main clinical manifestations were fever(51.6％), abdominal pain(50.0％), weight loss(31.2％), loss of appetite(25.0％), tiredness/weakness(21.9％), and nausea/vomiting(20.3％). Low-density space-occupying lesions were the main features on CT image. The diagnosis was confirmed by histopathological and/or bacteriological testing in 59 patients. Five patients were diagnosed after diagnostic anti-tuberculosis treatment was effective. Overall, 36 patients were cured, 19 improved, and 3 died.Conclusions The clinical symptoms of hepatic tuberculosis are atypical. Imaging combined with histopathological examination of the liver is the preferred method for diagnosis of hepatic tuberculosis. Anti-tuberculosis treatment and timely surgical treatment is usually effective with good outcomes.

Tuberculoma hepático que simula metástasis de carcinoma neuroendocrino gástrico / Hepatic tuberculoma simulating metastasis of gastric neuroendocrine carcinoma

La tuberculosis es una de las enfermedades infecciosas más frecuentes de distribución mundial, con una amplia presentación clínica. La afectación hepática de la tuberculosis es poco frecuente, pero más infrecuente aún lo es el tuberculoma hepático. Se presenta el caso de una paciente con tuberculoma hepático solitario que simula metástasis hepática secundaria a tumor neuroendocrino

Tuberculosis is one of the most common infectious diseases, with worldwide distribution and ample clinical manifestations. Hepatic tuberculosis is rare but hepatic tuberculoma is even rarer. We report an unusual case of a solitary hepatic tuberculoma simulating hepatic metastasis of a neuroendocrine tumor

CT characteristics of the sero-hepatic type of hepatic tuberculosis / 中华肝胆外科杂志

Objective To study the CT features of the sero-hepatic type of hepatic tuberculosis.Methods This is a retrospective,multi-center and cross-sectional study.17 patients with the sero-hepatic type of hepatic tuberculosis from the Yueqing People' s Hospital (n =5),Second Affiliated Hospital of Wenzhou Medical College (n =5),and Wenzhou People's Hospital (n =7) were studied.All these patients were fasted for 8 h prior to CT scanning.They underwent enhanced after conventional CT breathless scanning with no abdominal pressure.Results The CT scans displayed 41 lesions in these 17 patients with the sero-hepatic type of hepatic tuberculosis,including a solitary lesion in 13 patients and multiple lesions in 4 patients.The diameter of the lesions varied from 0.8 to 4.7 cm,with a mean ± S.D.of 2.38 ± 4.82 cm.The CT features showed a localized spindle-shaped focal lesion just underneath the liver capsule with resultant concave compression of the adjacent liver tissue (n =22),spotted calcifications in the center of the focal nodules (n =1);and aggregation of multiple low density nodular foci (n =19).Additional CT features included focal nodules surrounded by a small amount of liquid (n =15),compression of adjacent liver tissue (n =22),a small amount of ascites (n =8),and retroperitoneal lymph nodes enlargement (n =2).These nodules showed moderate (n =5) and slight enhancement in the arterial phase (n =36);moderate (n =32) and mild enhancement in the portal venous phase (n =9);and moderate (n =32) and mild enhancement in the parenchymal phase (n =9),respectively.The nodules showed ring-shaped (n =26),honeycomb or multiple ring-shaped enhancement (n =15).The enhanced ring-shaped wall thickness varied from 0.2 to 0.9 cm,with a thin wall (n =30) and a thick wall (n =11).The center of the focal nodule was a low density sac-shaped area,with no obvious contrast enhancement.The CT value was 21 to 39 hu.The infiltrative liver tissues which surrounded the focal nodules were shown as lamellar areas of obvious arterial enhancement,with equidensity in the portal vein phase and equilibrium phase.Conclusions CT showed characteristic features of the sero-hepatic type of hepatic tuberculosis.Clinical and laboratory findings could provide important supplementary information to make the diagnosis.

Primary Hepatic Tuberculosis Mimicking Hepatocelluar Carcinoma in Patient with Chronic Viral Hepatitis B and C / 계명의대학술지

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.

Macronodular hepatic tuberculosis mimicking hydatid cyst: A case report.

Isolated hepatic tuberculosis is called hepatic tuberculoma. It is a very rare granulomatous liver disease and constitutes less than 1% of all tuberculosis cases. Its clinical features are non- Specific Imaging-guided fine needle aspiration biopsy by ultrasonography or computed tomography (CT) is the best way to confirm the diagnosis The patients are treated with a combination of medicine such as rifampicin, isoniazid, ethambutol, and pyrazinamide. Here, we have reported a case of 42- year old male patient with macronodular hepatic tuberculosis. His CT imaging was reported as type IV hydatid cyst and also had a positive indirect hemagglutination test.

Primary nodular hepatic tuberculosis mimicking hepatic neoplasia in an immunocompetent host

We present and describe a case of nodular primary hepatic tuberculosis mimicking hepatic neoplasia in an immunocompetent host. This particularly rare presentation, associated with unspecific imaging, laboratory andclinical findings and relatively unspecific microbiological results make diagnosis extremely difficult, usually requiring surgical intervention.

Clinical features of hepatic tuberculosis in biopsy-proven cases / 대한간학회지

BACKGROUNDS/AIMS: Hepatic involvement is frequently observed in patients with miliary tuberculosis, but primary hepatic tuberculosis with no clinical extrahepatic manifestations of tuberculosis is uncommon. With the ever-increasing number of immunocompromised patients, it is expected that hepatic tuberculosis will occur more frequently. The aim of the present study was to establish the clinical manifestations and course of the disease. METHODS: From January 1989 to September 2008, 12 patients were diagnosed with hepatic tuberculosis by liver biopsy at Seoul National University Hospital. We retrospectively evaluated their clinical, laboratory, and imaging findings by medical record review. RESULTS: Four patients had primary hepatic tuberculosis, and eight patients had hepatic tuberculosis secondary to pulmonary or miliary tuberculosis. Three patients were immunocompromised, and six patients had no previous medical problem. An elevated serum level of alkaline phosphatase was the most frequently observed finding in laboratory tests. Imaging studies showed variable findings, including hepatosplenomegaly, multiple hepatic nodules, abscess formation, and even normal findings. Ten patients responded to antituberculosis drugs, and two cases with tuberculous liver abscess had persistent disease despite prolonged therapy. CONCLUSIONS: In patients with a protracted illness, hepatosplenomegaly and/or abnormal liver function tests, hepatic tuberculosis should be suspected, even in healthy young patients or patients with normal imaging findings. Patients with tuberculous abscess formation tend to respond poorly to antituberculosis therapy, and surgery could be considered in these patients.

Primary Hepatic Tuberculoma Associated with Intrahepatic Duct Stones and Abscess

Tuberculosis is a systemic disease that can occur anywhere in body. Its incidence is various according to the organ or location, and TB in an organ where the general incidence is rare causes so many unexpected symptoms and complications that physicians can sometimes be baffled when attempting to make a diagnosis. If this rare occurrence of TB in an unusual location results in non-specific symptoms, then it is important not to overlook the possibility of tuberculosis. Hepatic tuberculosis is mainly a secondary type of disease that has disseminated from the lungs or other organs. Because a primary TB focus in the liver is rare, in the case in which the lung or other organs have no tuberculosis, it is extremely difficult to arrive at the proper diagnosis of primary hepatic tuberculosis. The authers experienced a case of primary tuberculous granuloma that was associated with intrahepatic duct stones and abscess. This patient was first diagnosed as suffering with intrahepatic duct stones and abscess only. We discovered the associated tuberculous granuloma of the liver by histologic examination after hepatectomy. We report on this case with a review of the relevant literature.

A Case of Hypercalcemia Associated with Hepatic Tuberculosis / 대한내분비학회지

In this report, a 70-year-old female patient was detected with laboratory findings of hypercalcemia. The most common causes of hypercalcemia are primary hyperparathyroidism and malignant disease. Her laboratory tests did not show any evidence for neither primary hyperparathyroidism nor malignant diseases. Thus, granulomatous disease was suspected as the cause of the hypercalcemia. Liver MRI (magnetic resonance image) was performed on the subject, which suggested the presence of hepatic tuberculosis and sarcoidosis. Because the chest x-ray did not show a definite tuberculous lesion, we performed a laparoscopic liver biopsy for a final diagnosis. Findings from the biopsy specimen showed typical tuberculosis. After treatment with tuberculosis medication, hypercalcemia of the subject was resolved. Hypercalcemia is a well recognized as a possible complication of active pulmonary tuberculosis. But one should consider hepatic tuberculosis without pulmonary tuberculosis as a cause of hypercalcemia.

A Case of Hepatic Tuberculosis Diagnosed by Peritonescopy with Liver Biopsy / 대한소화기내시경학회지

Studies on hepatic tuberculosis are rare in Korea except several case repots. This is the first report on hepatic tuberculosis confirmed by the peritoneoscopic liver biopsy in Korea. A 43-year-old man was admitted due to high fever and cough for l0 days. On physical examination moist rale was audible on the both lower lung fields and hepatomegaly was noted. Chest X-ray revealed multiple fine granularity scattered uniformly throughout the both lung fields compatible with miliary pulmonary tuberculosis. On blood chemistry, SGOT, SGPT and alkaline phosphatase were elevated. Peritoneascopy revealed multiple yellowish-white small nodules evenly acattered on the entire surface of the both lobes of the liver and the needle biopsy of the liver showed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis consistent with hepatic tuberculosis. The patient was treated with antituberculous medications. Chest X-ray 6 months after treatment revealed completely healed miliary pulmonary tuberculosis and on blood chemistry 200 days after therapy SGOT, SGPT and alkaline phosphatase were within normal limits.