Liver Tuberculosis presenting as an uncommon cause of pyrexia of unknown origin: positron emission tomography/computed tomography identifies the correct site for biopsy

ABSTRACT

To identify the correct site to biopsy in a case of pyrexia of unknown origin [PUO] caused by hepatic tuberculosis [TB]. A 58-year-old man who developed hepatic TB presented with PUO. Ultrasonography [US] and computed tomography [CT] of the abdomen showed only calcifications in the liver, and positron emission tomography [PET]/CT showed diffuse increased metabolic activity in addition to focal areas of increased activity. A diagnosis of hepatic TB was confirmed by histological examination of liver tissues and interferon-Y release assays [IGRAs of T-SPOT/TB]. The patient was treated with 4 anti-tubercular therapies [rifampicin, isoniazid, ethambutol and pyrazinamide]. At the 3-month follow-up, the patient was disease free as confirmed by abdominal US. PET/CT was helpful in identifying a site to biopsy that led to the correct diagnosis