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1.
Tunis Med ; 101(12): 925-927, 2023 12 05.
Article in English | MEDLINE | ID: mdl-38477202

ABSTRACT

Isolated hepatic tuberculosis is a rare form of extrapulmonary tuberculosis. We report an exceptional case of a 51-year-old female patient complaining from right upper abdominal quadrant pain, who underwent laparoscopic surgery for millimetric gallbladder polyps. Preoperative ultrasound hepatic morphology and biochemical hepatic tests revealed no abnormalities. There were no clinical patterns for an active tuberculosis. During surgery time, scattered sub-centimeter whitish nodular lesions were discovered on the upper surface of the liver. Although gallbladder pathological examination did not reveal any significant abnormalities, per surgery hepatic biopsy indicated the presence of a giant cell granuloma with caseous necrosis highly suggestive of hepatic tuberculosis. Treatment by anti-bacillary drugs according to local standard protocol was conducted with favorable outcomes. Therefore, diagnosis of hepatic tuberculosis may be considered in endemic countries in totally asymptomatic patients or complaining from unexplained and isolated abdominal pain, in absence of any morphologic or biochemical hepatic abnormalities.


Subject(s)
Cholecystectomy, Laparoscopic , Tuberculosis, Hepatic , Female , Humans , Middle Aged , Abdomen , Abdominal Pain/etiology , Biopsy , Tuberculosis, Hepatic/complications
2.
Am J Med Sci ; 363(6): 552-555, 2022 06.
Article in English | MEDLINE | ID: mdl-35296407

ABSTRACT

Hepatic tuberculosis (TB) is a rare type of extrapulmonary TB. Due to the nonspecific clinical symptoms and imaging manifestations, hepatic TB with human immunodeficiency virus (HIV) infection is easy to be misdiagnosed. We report a case of hepatic TB with acquired immune deficiency syndrome (AIDS), which was initially misdiagnosed as general bacterial liver abscess even after the patient received needle biopsy. In subsequent process, pathogenic tests using washing solution of punctured liver tissue sample were proved feasible, convenient, and specific for pathogenic diagnosis in resource-limited areas of China. For liver abscess in patients with HIV, the pathogens are more complex than HIV negative patients. Some uncommon pathogens, such as TB and fungi, should also be taken into consideration. For the hepatic TB without abscess formation, pathogenic test using washing solution of punctured liver tissue sample should be attached importance.


Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Liver Abscess , Tuberculosis, Hepatic , Tuberculosis , Acquired Immunodeficiency Syndrome/complications , Humans , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Hepatic/drug therapy
3.
BMC Surg ; 21(1): 2, 2021 Jan 02.
Article in English | MEDLINE | ID: mdl-33388034

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. CASE PRESENTATION: We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. CONCLUSION: A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.


Subject(s)
Carcinoma, Hepatocellular/complications , Liver Neoplasms/complications , Liver/diagnostic imaging , Tuberculosis, Hepatic/complications , Abdominal Pain/etiology , Carcinoma, Hepatocellular/diagnosis , Female , Fever/etiology , Humans , Liver/pathology , Liver Neoplasms/diagnosis , Male , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Hepatic/diagnosis
4.
Glob Health Sci Pract ; 8(1): 28-37, 2020 03 30.
Article in English | MEDLINE | ID: mdl-32041772

ABSTRACT

BACKGROUND: The focused assessment with sonography for HIV-associated tuberculosis (TB) (FASH) ultrasound protocol has been increasingly used to help clinicians diagnose TB. We sought to quantify the diagnostic utility of FASH for TB among individuals with HIV in Malawi. METHODS: Between March 2016 and August 2017, 210 adults with HIV who had 2 or more signs and symptoms that were concerning for TB (fever, cough, night sweats, weight loss) were enrolled from a public HIV clinic in Lilongwe, Malawi. The treating clinicians conducted a history, physical exam, FASH protocol, and additional TB evaluation (laboratory diagnostics and chest radiography) on all participants. The clinician made a final treatment decision based on all available information. At the 6-month follow-up visit, we categorized participants based on clinical outcomes and diagnostic tests as having probable/confirmed TB or unlikely TB; association of FASH with probable/confirmed TB was calculated using Fisher's exact tests. The impact of FASH on empiric TB treatment was determined by asking the clinicians prospectively about whether they would start treatment at 2 time points in the baseline visit: (1) after the initial history and physical exam; and (2) after history, physical exam, and FASH protocol. RESULTS: A total of 181 participants underwent final analysis, of whom 56 were categorized as probable/confirmed TB and 125 were categorized as unlikely TB. The FASH protocol was positive in 71% (40/56) of participants with probable/confirmed TB compared to 24% (30/125) of participants with unlikely TB (odds ratio=7.9, 95% confidence interval=3.9,16.1; P<.001). Among those classified as confirmed/probable TB, FASH increased the likelihood of empiric TB treatment before obtaining any other diagnostic studies from 9% (5/56) to 46% (26/56) at the point-of-care. For those classified as unlikely TB, FASH increased the likelihood of empiric treatment from 2% to 4%. CONCLUSION: In the setting of HIV coinfection in Malawi, FASH can be a helpful tool that augments the clinician's ability to make a timely diagnosis of TB.


Subject(s)
HIV Infections/complications , Point-of-Care Testing , Tuberculosis/diagnostic imaging , Adult , Antitubercular Agents , Ascites/diagnostic imaging , Ascites/etiology , Cohort Studies , Coinfection , Female , Humans , Lipopolysaccharides/urine , Liver/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Malawi , Male , Middle Aged , Nucleic Acid Amplification Techniques , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Prospective Studies , Radiography, Thoracic , Spleen/diagnostic imaging , Tuberculosis/complications , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnostic imaging , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/diagnostic imaging , Tuberculosis, Splenic/complications , Tuberculosis, Splenic/diagnostic imaging , Ultrasonography/methods
5.
Trop Doct ; 49(4): 320-322, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31335264

ABSTRACT

Liver abscesses, either pyogenic or amoebic, with or without the involvement of the pleura, are not infrequently encountered in children. Isolated tubercular liver abscess without active pulmonary, gastrointestinal or other clinical evidence of tuberculosis is, however, rare and more so its rupture into the pleura. We report a case of a 14-year-old girl who presented with a liver abscess rupturing into the pleura causing an empyema. Successful management was achieved by intercostal tube drainage and antitubercular treatment.


Subject(s)
Liver Abscess/complications , Tuberculosis, Hepatic/complications , Tuberculosis, Pleural/etiology , Adolescent , Antitubercular Agents/therapeutic use , Drainage , Female , Humans , Liver Abscess/drug therapy , Liver Abscess/pathology , Treatment Outcome , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Hepatic/pathology , Tuberculosis, Pleural/drug therapy , Tuberculosis, Pleural/pathology , Tuberculosis, Pleural/surgery
6.
BMC Infect Dis ; 19(1): 217, 2019 Mar 04.
Article in English | MEDLINE | ID: mdl-30832669

ABSTRACT

BACKGROUND: Hepatobiliary tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection, especially in younger patients. The non-specific symptoms and signs as well as the lack of definite imaging characteristics often impedes diagnosis. Definite diagnosis of tuberculosiscan be obtained through histopathological examination; conventional anti-tuberculosis drugs and surgery are the most commonly recommended treatments. CASE PRESENTATION: A previously healthy 15-year-old rural adolescent male presented with a 2-month history of weight loss and fatigue. We strongly suspected a Klatskin tumor; therefore, exploratory laparotomy was performed. However, the microscopical findings revealed a granuloma consisting of epithelioid cells, caseous necrosis, and lymphocytic infiltration, indicating caseating granulomatous inflammation and yielding a final diagnosis of hepatic hilar tuberculosis. CONCLUSION: Hepatic hilar tuberculosis is an extremely rare case; few physicians may have actually treated a case. This report therefore aims to improve the overall understanding of lymphatic tuberculosis of the hepatic hilum.


Subject(s)
Biliary Tract Diseases/diagnosis , Tuberculosis, Hepatic/diagnosis , Adolescent , Antitubercular Agents/therapeutic use , Biliary Tract Diseases/complications , Biliary Tract Diseases/pathology , Epithelioid Cells/cytology , Fatigue/etiology , Granuloma/pathology , Humans , Male , Necrosis , Tomography, X-Ray Computed , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Hepatic/pathology , Weight Loss
7.
Clin J Gastroenterol ; 12(1): 57-62, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30145769

ABSTRACT

This report describes a case of liver hilar tuberculous lymphadenitis complicated by biliary stricture, diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). A 44-year-old woman was referred to our center for further evaluation of abnormal liver function tests. Abdominal ultrasound/contrast-enhanced computed tomography (CT) revealed a 15-mm hypovascular mass with a weakly enhanced margin at the liver hilum. Magnetic resonance cholangiopancreatography revealed dilatation of the intrahepatic bile ducts in the left lobe of liver and gradual narrowing of the left hepatic duct. Biliary stricture associated with enlarged hilar lymph nodes due to metastasis or malignant lymphoma was suspected, but calcification on chest CT and a positive T-SPOT test did not rule out tuberculosis. After transpapillary brush cytology of the bile duct stricture failed to confirm the diagnosis, EUS-FNA of hilar lymph nodes was performed and showed positive for the acid-fast bacillus and polymerase chain reaction for Mycobacterium tuberculosis DNA as well as epithelioid granulomas on pathological evaluation. Those findings led to a diagnosis of hilar tuberculous lymphadenitis. The patient is under treatment with antituberculosis drugs. Abdominal tuberculous lymphadenitis is rare and some cases diagnosed as lymphadenopathy of unknown origin have required surgery. EUS-FNA is a safe and minimally invasive diagnostic method in such cases.


Subject(s)
Cholestasis, Intrahepatic/etiology , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/diagnosis , Adult , Antitubercular Agents/therapeutic use , Cholangiopancreatography, Magnetic Resonance , Contrast Media , Female , Humans , Tomography, X-Ray Computed/methods , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Lymph Node/drug therapy , Ultrasonography
8.
Medicine (Baltimore) ; 97(36): e12255, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30200160

ABSTRACT

RATIONALE: Tuberculosis remains a serious menace to the health of people. Isolated hepatic tuberculosis is rare and pancreatic tuberculosis is extremely rare. The preoperative diagnosis of pancreatic tuberculosis remains a great challenge. PATIENT CONCERNS: A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month. DIAGNOSES: Computed tomography (CT) of the abdomen showed a hypodense mass in the pancreatic head and neck with abundant calcifications, a hypodense lesion in the liver without calcification, peripancreatic lymphadenopathy, calcifications in some lymph nodes. CT-guided fine needle aspiration biopsy of the hepatic lesion was carried out and the cytological examination revealed hepatic tuberculosis. INTERVENTIONS: The patient was treated with antituberculous therapy for 1 year. OUTCOMES: Low back pain and abdominal pain disappeared 3 months after initial treatment and after 2 year of follow-up, the patient was asymptomatic. LESSONS: Our data hint that calcifications in both pancreatic lesions and peripancreatic lymph nodes may suggest pancreatic tuberculosis rather than pancreatic malignancy.


Subject(s)
Calcinosis/complications , Calcinosis/diagnosis , Lymphatic Diseases/complications , Lymphatic Diseases/diagnosis , Pancreatic Diseases/complications , Tuberculosis, Hepatic/complications , Antitubercular Agents/therapeutic use , Calcinosis/drug therapy , Diagnosis, Differential , Female , Humans , Lymph Nodes/diagnostic imaging , Lymphatic Diseases/drug therapy , Middle Aged , Pancreas/diagnostic imaging , Pancreatic Diseases/diagnosis , Pancreatic Diseases/drug therapy , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Hepatic/drug therapy
9.
Indian J Tuberc ; 65(3): 266-267, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29933873

ABSTRACT

Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.


Subject(s)
Common Bile Duct Diseases/diagnosis , Tuberculosis, Hepatic/diagnosis , Antitubercular Agents/therapeutic use , Biopsy, Fine-Needle , Cholestasis/etiology , Common Bile Duct Diseases/complications , Common Bile Duct Diseases/diagnostic imaging , Common Bile Duct Diseases/drug therapy , Constriction, Pathologic/complications , Constriction, Pathologic/diagnosis , Diagnosis, Differential , Humans , Jaundice/etiology , Male , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Hepatic/pathology , Young Adult
10.
Indian J Tuberc ; 65(2): 172-174, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29579434

ABSTRACT

Hypercalcemia might present itself in association with granulomatous diseases such as tuberculosis. We report a rare case of a 62-year-old man with hypercalcemia due to hepatic tuberculosis. The diagnosis was based on laparoscopic and a histopathological examination. After treatment with anti-tuberculosis medication, the patient's serum calcium levels were within normal limits. Tuberculosis needs to be excluded as a diagnosis in any febrile patient with hypercalcemia, especially in countries where tuberculosis is endemic.


Subject(s)
Hypercalcemia/etiology , Tuberculosis, Hepatic/diagnosis , Biopsy , Diagnosis, Differential , Humans , Hypercalcemia/blood , Male , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnostic imaging , Tuberculosis, Hepatic/pathology
11.
BMC Gastroenterol ; 17(1): 126, 2017 Nov 28.
Article in English | MEDLINE | ID: mdl-29179696

ABSTRACT

BACKGROUND: Hepatobiliary tuberculosis includes miliary, tuberculous hepatitis or localized forms. The localised form is extremely uncommon and can mimic malignancy. Still rarer is its presentation as sclerosing cholangitis. CASE PRESENTATION: A 50 year male presented with acute onset jaundice, significant weight loss and elevated liver enzymes with clinico-radiological suspicion of cholangiocarcinoma. A left hepatectomy was done and dilated bile ducts filled with caseous necrotic material were seen intra-operatively. Histopathology suggested localized hepatobiliary tuberculosis with features of secondary sclerosing cholangitis. CONCLUSION: Localised hepatobiliary tuberculosis can cause diagnostic difficulties and its possibility should be considered especially in endemic areas.


Subject(s)
Biliary Tract Diseases/complications , Biliary Tract Diseases/diagnosis , Cholangitis, Sclerosing/etiology , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnosis , Bile Duct Neoplasms/diagnosis , Biliary Tract Diseases/pathology , Biliary Tract Diseases/surgery , Cholangiocarcinoma/diagnosis , Diagnosis, Differential , Hepatectomy , Humans , Male , Middle Aged , Necrosis , Tuberculosis, Hepatic/pathology , Tuberculosis, Hepatic/surgery
12.
BMC Infect Dis ; 17(1): 115, 2017 02 01.
Article in English | MEDLINE | ID: mdl-28148232

ABSTRACT

BACKGROUND: Although Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults. METHODS: Retrospective study of patients diagnosed with hepatic TB from 2005-2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. RESULTS: Among twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/µl (inter-quartile range 27-107 cells/µl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322-1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235-736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died. CONCLUSION: In our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.


Subject(s)
HIV Infections/complications , Tuberculosis, Hepatic/complications , Adult , CD4 Lymphocyte Count , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Mycobacterium tuberculosis , Retrospective Studies , South Africa , Tuberculosis, Multidrug-Resistant/complications , Tuberculosis, Pulmonary/complications , Young Adult
13.
Nat Med ; 22(12): 1470-1474, 2016 12.
Article in English | MEDLINE | ID: mdl-27798613

ABSTRACT

Mycobacterium tuberculosis remains a leading cause of death worldwide, especially among individuals infected with HIV. Whereas phylogenetic analysis has revealed M. tuberculosis spread throughout history and in local outbreaks, much less is understood about its dissemination within the body. Here we report genomic analysis of 2,693 samples collected post mortem from lung and extrapulmonary biopsies of 44 subjects in KwaZulu-Natal, South Africa, who received minimal antitubercular treatment and most of whom were HIV seropositive. We found that purifying selection occurred within individual patients, without the need for patient-to-patient transmission. Despite negative selection, mycobacteria diversified within individuals to form sublineages that co-existed for years. These sublineages, as well as distinct strains from mixed infections, were differentially distributed throughout the lung, suggesting temporary barriers to pathogen migration. As a consequence, samples taken from the upper airway often captured only a fraction of the population diversity, challenging current methods of outbreak tracing and resistance diagnostics. Phylogenetic analysis indicated that dissemination from the lungs to extrapulmonary sites was as frequent as between lung sites, supporting the idea of similar migration routes within and between organs, at least in subjects with HIV. Genomic diversity therefore provides a record of pathogen diversification and repeated dissemination across the body.


Subject(s)
DNA, Bacterial/genetics , HIV Infections/complications , Liver/microbiology , Lung/microbiology , Lymph Nodes/microbiology , Mycobacterium tuberculosis/genetics , Spleen/microbiology , Tuberculosis/microbiology , Adult , Aged , Autopsy , Bacteriological Techniques , Coinfection/microbiology , Female , Genetic Variation , Humans , Male , Middle Aged , Phylogeny , Polymorphism, Single Nucleotide , South Africa , Tuberculosis/complications , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/microbiology , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/microbiology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Splenic/complications , Tuberculosis, Splenic/microbiology
14.
Klin Med (Mosk) ; 94(5): 388-91, 2016.
Article in Russian | MEDLINE | ID: mdl-30289653

ABSTRACT

Tuberculous lesions of the liver frequently occur in autopsy material, even though most of them are clinically unapparent. Pathogenetically, hepatic tuberculosis is a manifestation of general military tuberculosis with the infection brought in through the hematogenous route (through the hepatic artery or the portal system) as a result of intestinal or mesenteric lymph node tuberculosis. We report a case of combination of hepatic tuberculosis and diabetes mellitus in a young woman with reference to the clinical course of the disease, its diagnostics and treatment.


Subject(s)
Antitubercular Agents/administration & dosage , Fatty Liver , Liver , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Hepatic , Biopsy/methods , Fatty Liver/diagnosis , Fatty Liver/etiology , Fatty Liver/physiopathology , Female , Humans , Liver/diagnostic imaging , Liver/microbiology , Liver/pathology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/etiology , Liver Cirrhosis/physiopathology , Liver Function Tests/methods , Middle Aged , Tomography, Spiral Computed/methods , Treatment Outcome , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Hepatic/therapy
15.
BMJ Case Rep ; 20152015 Jul 07.
Article in English | MEDLINE | ID: mdl-26153294

ABSTRACT

Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.


Subject(s)
Abdominal Pain/etiology , Antitubercular Agents/administration & dosage , Tomography, X-Ray Computed , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Splenic/diagnosis , Diagnosis, Differential , Ethambutol/administration & dosage , Female , Humans , Isoniazid/administration & dosage , Middle Aged , Pyrazinamide/administration & dosage , Rifampin/administration & dosage , Treatment Outcome , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Splenic/complications , Tuberculosis, Splenic/drug therapy , Weight Loss
16.
BMC Infect Dis ; 15: 209, 2015 May 06.
Article in English | MEDLINE | ID: mdl-25943103

ABSTRACT

BACKGROUND: Mycobacterium tuberculosis (TB) infection of the liver, known as hepatic TB, is an extrapulmonary manifestation of TB. Hepatic TB has become more prevalent, likely as a result of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. We sought to review case series to characterize the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of hepatic TB and to comment on the impact of HIV co-infection on these characteristics. METHODS: We conducted a systematic literature search in PubMed and ScienceDirect for articles pertaining to hepatic TB with human subjects from 1960 to July 2013. RESULTS: We obtained data on 618 hepatic TB patients from 14 case series. The most common reported signs and symptoms were hepatomegaly (median: 80%, range: 10-100%), fever (median: 67%, range: 30-100), respiratory symptoms (median: 66%, range: 32-78%), abdominal pain (median: 59.5%, range: 40-83%), and weight loss (median: 57.5%, range: 20-100%). Common laboratory abnormalities were elevated alkaline phosphatase and gamma-glutamyl transferase. Ultrasound and computerized tomography (CT) were sensitive but non-specific. On liver biopsy, smear microscopy for acid-fast bacilli had a median sensitivity of 25% (range: 0-59%), histology of caseating granulomas had a median sensitivity of 68% (range: 14-100%), and polymerase chain reaction for TB had a median sensitivity of 86% (range: 30-100%). Standard anti-tuberculous chemotherapy for 6 to 12 months achieved positive outcomes for nearly all patients with drug-susceptible TB. CONCLUSIONS: Clinicians in TB-endemic regions should maintain a high index of suspicion for hepatic TB in patients presenting with hepatomegaly, fever, respiratory symptoms, and elevated liver enzymes. The most sensitive imaging modality is a CT scan, while the most specific diagnostic modality is a liver biopsy with nucleic acid testing of liver tissue samples. Upon diagnosis, 4-drug anti-TB therapy should promptly be initiated. HIV co-infected patients may have more complex cases and should be closely monitored for complications.


Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Mycobacterium tuberculosis , Tuberculosis, Hepatic/epidemiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/drug therapy , Coinfection , Global Health , Humans , Nucleic Acid Amplification Techniques , Prevalence , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Hepatic/drug therapy
17.
BMJ Case Rep ; 20152015 Mar 02.
Article in English | MEDLINE | ID: mdl-25733085

ABSTRACT

A 30-year-old afebrile woman presented with anorexia, yellowish discolouration of the sclera and bilateral pedal oedema. Blood investigations revealed severe anaemia, raised erythrocyte sedimentation rate and thrombocytopaenia. Liver function tests were abnormal with raised bilirubin, alanine transaminase and prothrombin time. Chest roentgenogram was negative for tuberculosis. Abdominal ultrasonography (USG) revealed coarsened echotexture of the liver with surface nodularity. Contrast-enhanced CT scan revealed heterogeneity with surface and parenchymal nodularity scattered throughout the liver parenchyma. USG-guided liver biopsy was performed, which showed changes in granulomatous hepatitis with positive Ziehl-Neelsen staining for acid-fast bacilli. The patient was started on antituberculous drugs. After completion of the antituberculous regimen, the patient made an uneventful recovery with normal range of aspartate aminotransferase, serum albumin and prothrombin time. In summary, isolated liver tuberculosis is rare and a high index of suspicion is required in a patient from an area where tuberculosis is endemic, after excluding other common diffuse liver pathologies.


Subject(s)
Jaundice/etiology , Tuberculosis, Hepatic/diagnosis , Adult , Antitubercular Agents/therapeutic use , Female , Humans , Image-Guided Biopsy , Liver/diagnostic imaging , Liver/pathology , Liver Function Tests , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/drug therapy , Ultrasonography
18.
Rev Gastroenterol Peru ; 35(4): 318-22, 2015.
Article in Spanish | MEDLINE | ID: mdl-26802885

ABSTRACT

OBJECTIVE: To present our experience with abdominal tuberculosis in children and adolescents treated in our hospital from 2003 - 2014. MATERIAL AND METHODS: It is a retrospective study. We have collected clinical records of inpatients <20 years old who were admitted at Hipolito Unanue Hospital from January 2003 to July 2014, with diagnosis of abdominal tuberculosis. RESULTS: Among the overall 30 patients, 16 (53.33%) were female and 14 (46.67%) were male. The mean age of all patients was 16.5 years. The most common clinical features were abdominal pain in 29 (96.67%), fever in 26 (86.67%), ascites in 23 (76.67%) and loss of weight in 21 (70%). 63.33% of the patients were eutrophics, 13.34% were overweight or obese and only 23.33% suffered of malnutrition. TB contact was present in 10 (33.33%). Positive tuberculin skin tests were seen in 10%. Extra-abdominal tuberculosis was found in 22 patients (63.32%). 12 cases had coexisting pulmonary tuberculosis and 4 cases had pleural effusion. 12 patients (40%) had tuberculous peritonitis; 12 patients (40%) had intestinal tuberculosis and peritoneal tuberculosis and 4 patients (13.33%) had intestinal tuberculosis. Bacteriological confirmation of tuberculosis was achieved in 10 cases (33.33%). Antituberculous therapy for 6 months was effective in 29 cases. One patient died who multifocal tuberculosis with HIV had associated. CONCLUSIONS: Abdominal tuberculosis is seen in 4.37% of children affected with tuberculosis, of which over 63% will have extra abdominal manifestations. Abdominal tuberculosis should be considered in patients with abdominal pain, fever, weight loss and abnormal chest radiography. Imaging can be useful for early diagnosis of abdominal tuberculosis.


Subject(s)
Peritonitis, Tuberculous/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Lymph Node/diagnosis , Adolescent , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Male , Peritonitis, Tuberculous/complications , Peritonitis, Tuberculous/drug therapy , Peru , Retrospective Studies , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/drug therapy , Young Adult
20.
Clin Respir J ; 9(4): 501-5, 2015 Oct.
Article in English | MEDLINE | ID: mdl-24865423

ABSTRACT

BACKGROUND AND AIMS: Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affect lungs. Most hepatic tuberculosis could be a part of systemic miliary tuberculosis. METHODS: We reported a case of pulmonary tuberculosis combined with hepatic tuberculosis and reviewed the relevant literature. RESULTS: A 40-year-old Chinese male with fatigue for half a year and cough as well as night sweat for 2 months was admitted to our hospital. The chest computed tomography (CT) showed multiple nodules combined with bronchial stenosis and lymphadenectasis in the mediastina at the right hilum of lung. The epigastrium CT showed lumps in the liver and retroperitoneal lymphadenectasis in the peritoneal cavity. The abdominal color Doppler ultrasound revealed lumps in the liver. The lung and liver puncture biopsy revealed granulomatous lesions, chronic inflammatory changes in the strip-like fibrous tissues and plenty of caseification, all of which suggest the diagnosis of tuberculosis. CONCLUSION: Hepatic tuberculosis is usually associated with atypical clinical manifestations. Imageological examination combined with imaging-guided fine needle aspiration biopsy may be the best method for the confirmed diagnosis.


Subject(s)
Tuberculosis, Hepatic/drug therapy , Tuberculosis, Pulmonary/drug therapy , Adult , Antitubercular Agents/therapeutic use , Comorbidity , Diagnosis, Differential , Humans , Male , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis, Hepatic/complications , Tuberculosis, Hepatic/diagnostic imaging , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnostic imaging , Ultrasonography, Doppler, Color
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