Hepatitis granulomatosa en paciente con tuberculosis miliar: presentación de un caso / Granulomatous hepatitis in a patient with Miliary Tuberculosis: presentation of a case

La hepatitis granulomatosa como elemento inicial de una enfermedad tuberculosa es muy poco frecuente. El rendimiento de las pruebas para el diagnóstico de tuberculosis hepática resulta baja, siendo las principales causas de granulomatosis hepática las infecciones (tuberculosis, brucelosis, hongos, parásitos, etc). En la tuberculosis miliar, durante la diseminación hemática, que ocurre en el desarrollo de la primoinfección, el hígado es capaz de recibir y albergar una carga considerable de bacilos por sus características anatomofuncionales que se agrupan en forma de granuloma, que es un patrón de reacción inflamatoria crónica en el que predomina un tipo especial de célula denominada macrófago. Esto es causa frecuente de síndrome febril prolongado de causa sistémica, puede debutar con manifestaciones clínicas poco precisas. Se presentó un caso del sexo masculino que ingresa en el servicio de Medicina del Hospital Militar Docente Dr Mario Muñoz Monroy, de Matanzas, que ingresa por cuadro de fiebre de origen desconocido, que resultó ser por esta causa.

Granulomatous hepatitis as initial element of a tubercular disease is few frequent; the efficacy of the tests for diagnosing hepatic tuberculosis is low, being infections (tuberculosis, brucellosis, fungi, parasites, etc). The main cause of hepatic granulomatosis. during the hematic dissemination in the miliary tuberculosis, occurring in the development of primo-infection, liver is able of receiving and dwelling a considerable charge of bacilli due to its anatomic functional characteristics; they group in the form of granulomas, a pattern of chronic inflammatory reaction, in which there is a predomination of an special kind of cells called macrophages; it frequently causes a prolonged febrile syndrome and may start with little precise clinical manifestations. We present the case of a male patient entering the Medicine Service of the Military Hospital Dr Mario Muñoz Monroy of Matanzas, with a picture of unknown origin fever, resulting being originated by this cause.

Tuberculosis hepática primaria como causa de fiebre de origen desconocido / Primary liver tuberculosis as a cause of fever of unknown origin

Se presenta el caso de un paciente de 29 años de edad, quien se presentó con un cuadro de fiebre, sudoración nocturna y pérdida de peso, el que inicialmente fue catalogado como dengue clásico, pero que al persistir, fue abordado como fiebre de origen desconocido. Debido a que las pruebas de laboratorio y gabinete iniciales no fueron concluyentes, fue necesario realizar una laparotomía exploratoria para obtener material histológico en el que se demostraron granulomas caseosos en el hígado y formas similares a micobacterias con las tinciones especiales. Con el tratamiento antifímico, se observó una respuesta clínica favorable, por lo que se concluye que el cuadro corresponde a una probable TB hepática.

Isolated tubercular liver abscess in children treated with percutaneous isoniazid infusion.

Isolated Tubercular liver abscess is mainly reported in adult patients. We report two cases of isolated tubercular liver abscess in paediatric patients. Diagnosis was made by clinical and ultrasound guided aspiration of pus showing acid fast bacilli in one case. In second case, biopsy of the abscess wall was confirmatory. In both cases percutaneous drainage of pus and transcatheter infusion of Isoniazid was given. After two weeks of infusion no acid fast bacilli was detected and cavity size decreased. Direct infusion of anti-tubercular drugs is more efficient than systemic therapy alone. This is first of its kind in treating isolated tubercular abscess in paediatric patients. So, percutaneous infusion of anti-tubercular agents can be considered in the treatment of tubercular liver abscess.

Micobacteriosis hepato-esplénica, forma inusual de probable tuberculosis extrapulmonar: Caso clínico y revisión bibliográfica / Hepatic-splenic micobacteriosis, unusual form of probable extrapulmonary tuberculosis: Case report and review

Reportamos el caso de un hombre de 42 años, seronegativo para VIH, con fiebre de origen desconocido (FOD), asociada a elevación de transaminasas y fosfatasas alcalinas con patrón colestásico e imágenes hepáticas hipodensas en la tomografía axial computada. La biopsia hepática demostró la presencia de granulomas tuberculosos con visualización de un bacilo con alcohol-ácido resistencia. El cuadro respondió al tratamiento con fármacos antituberculosos presentando caída de curva febril, mejoría del estado general y normalización de parámetros de laboratorio.

We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.

Localized hepatic tuberculosis presenting as fever of unknown origin

Localized hepatic tuberculosis is a rare clinical form of tuberculosis infection; it has signs and symptoms related only to hepatic injury, with minimal or no extrahepatic involvement. It frequently presents as a non-specific syndrome, with systemic manifestations, which can sometimes result in a diagnostic dilemma. A high index of suspicion is required and a definitive diagnosis can be very difficult. We report a case of localized hepatic tuberculosis that presented as fever of unknown origin.

Granulomatous hepatitis after intravesical BCG treatment for bladder cancer.

Intravesical bacillus Calmette-Guerin (BCG) is used in patients with urinary bladder carcinoma. Although it is generally well tolerated, granulomatous hepatitis is a rare but serious complication. We report a 42-year-old man and a 56-year-old man who developed granulomatous hepatitis following intravesical BCG. One of them was treated successfully with antitubercular therapy; the other died because of BCG sepsis and multi-organ failure.

Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient

We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm³), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.

Granulomatosis hepática de origen tuberculoso / Hepatic granulomatosis of tuberculous origin

Paciente del sexo femenino, de 54 años de edad y procedencia urbana, que ingresó en el Hospital General Dr Juan Bruno Zayas de Santiago de Cuba en agosto del 2005 por presentar moderada disnea, fiebre, astenia, anorexia y ligera pérdida de peso desde hacía aproximadamente un mes. Los diferentes exámenes indicados (pruebas complementarias, radiográficas y otras) revelaron la existencia de granulomas tuberculosos en el hígado. El tratamiento prescrito garantizó la evolución favorable en este caso

Tuberculoma hepático producido por Mycobacterium fortuitum: reporte de un caso / Liver tuberculoma induced by Mycobacterium fortuitum: report of a case

Se presenta el caso de una paciente con un tuberculoma hepático producido por Mycobacterium fortuitum. La paciente fue curada con cirurgía y un esquema de antibiótico consiste amikacina y doxiciclina. Este caso constituye la primera publicación de un tuberculoma hepático producido por Mycobacterium fortuitum