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Das CJ, Rednam N, Vora Z, Aggarwal A, Chandrashekhara SH, Kundra V. Abdominal visceral tuberculosis: a malignancy mimic. Abdom Radiol (NY) 2023; 48:2705-2715. [PMID: 37204509 PMCID: PMC10197054 DOI: 10.1007/s00261-023-03939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response.
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Affiliation(s)
- Chandan J. Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Zainab Vora
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Ankita Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - S. H. Chandrashekhara
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
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2
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Hu N, Wu Y, Tang M, Luo T, Yuan S, Li C, Lei P. Case report: Hepatic tuberculosis mimicking hepatocellular carcinoma in a patient with cirrhosis induced by hepatitis B virus. Front Med (Lausanne) 2022; 9:1005680. [PMID: 36457572 PMCID: PMC9705775 DOI: 10.3389/fmed.2022.1005680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
Hepatic tuberculosis (TB), which is secondary to post-hepatitis B cirrhosis, is extremely rare. We report the case of a 69-year-old man with post-hepatitis B cirrhosis complicated by primary isolated hepatic TB who was initially misdiagnosed as having hepatocellular carcinoma (HCC). The patient was hospitalized with complaints of 2 weeks of fever. He had a 20-year history of post-hepatitis B cirrhosis. The laboratory tests suggested that his serum alpha-fetoprotein (AFP) level was markedly elevated to 1210 ng/ml. From the abdominal ultrasound (US) and magnetic resonance imaging (MRI) images, we confirmed the presence of cirrhosis and discovered a space-occupying lesion of the hepatic left lobe as well as portal vein-filling defects. These results led us to consider primary liver cancer and portal vein tumor thrombus combined with decompensated cirrhosis. Biopsy and histology may be considered the ultimate diagnostic tests, but we excluded needle biopsy because of his high risk of bleeding, in addition, the patient declined the procedure. To cope with his fever, the patient was given broad-spectrum antibiotic treatment initially, followed by intravenous vancomycin. After antibiotic treatment had failed, the patient was treated with anti-TB for 10 days; after that, the patient maintained a normal temperature. The patient continued to receive tuberculostatic therapy for 6 months following his discharge. AFP completely returned to the normal level, and the aforementioned mass disappeared. Finally, hepatic TB secondary to post-hepatitis B cirrhosis with portal vein thrombosis (PVT) was considered to be the final diagnosis. More than two imaging techniques discover a space-occupying liver lesion and that the serum alpha-fetoprotein (AFP) level is extremely elevated, which means that hepatocellular carcinoma (HCC) could be diagnosed. However, some exceedingly rare diseases should not be excluded. This case illustrated that the non-invasive diagnostic criteria for liver cancer should be considered carefully when discovering a space-occupying liver lesion in a patient with cirrhosis and an elevated AFP level. In addition, primary hepatic TB should be considered and included in the differential diagnosis, and a biopsy should be performed promptly.
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Affiliation(s)
- Na Hu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tianyong Luo
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shengmei Yuan
- Department of Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Cai Li
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Pinggui Lei
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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3
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Zheng SM, Lin N, Tang SH, Yang JY, Wang HQ, Luo SL, Zhang Y, Mu D. Isolated hepatic tuberculosis associated with portal vein thrombosis and hepatitis B virus coinfection: A case report and review of the literature. World J Clin Cases 2021; 9:9310-9319. [PMID: 34786418 PMCID: PMC8567534 DOI: 10.12998/wjcc.v9.i30.9310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While tuberculosis (TB) itself is a common disease, isolated TB of the liver is a rare entity. Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma. In contrast, isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice, with only a few sporadic cases and short series available in the current literature. Vascular complications, such as portal vein thrombosis (PVT), have rarely been reported previously.
CASE SUMMARY A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg. He had a 10-year hepatitis B virus (HBV) infection in his medical history. Contrast-enhanced computed tomography (CECT) confirmed hepatosplenomegaly, with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein. A liver biopsy showed epithelioid granulomas with a background of caseating necrosis. Ziehl-Nelson staining showed acid-fast bacilli within the granulomas. The patient was diagnosed with isolated hepatic TB with PVT. Anti-TB therapy (ATT), including isoniazid, rifapentine, ethambutol, and pyrazinamide, was administered. Along with ATT, the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant. He remained asymptomatic, and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.
CONCLUSION Upon diagnosis of hepatic TB associated with PVT and HBV coinfection, ATT and anticoagulants should be initiated to prevent subsequent portal hypertension. Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.
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Affiliation(s)
- Shu-Mei Zheng
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Ning Lin
- Department of Clinical Nutrition, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shan-Hong Tang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Jia-Yi Yang
- School of Medical Imaging, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Hai-Qiong Wang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shu-Lan Luo
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Yong Zhang
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Dong Mu
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
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Romic I, Pavlek G, Romic M, Romic R. Isolated liver tuberculoma infiltrating anterior abdominal wall and skin. Liver Int 2021; 41:1129-1130. [PMID: 33316129 DOI: 10.1111/liv.14764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 02/13/2023]
Affiliation(s)
- Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Goran Pavlek
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Romic
- Department of Surgery, University Hospital Sestre Milosrdnice, Zagreb, Croatia
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5
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Niyogi D, Goel M, Shinde RS, Patkar S. Primary hepatic tuberculosis: A rare occurrence. Ann Hepatobiliary Pancreat Surg 2019; 23:80-83. [PMID: 30863814 PMCID: PMC6405358 DOI: 10.14701/ahbps.2019.23.1.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022] Open
Abstract
Primary hepatic tuberculosis is a rare entity and can closely mimic malignancy with respect to clinical presentation and imaging features. We identified five patients at a high volume tertiary care cancer center, whose clinical features and imaging closely mimicked primary liver malignancy or metastases but final histopathology was suggestive of hepatic tuberculosis. Three patients underwent a surgical resection whereas two were diagnosed on a biopsy. Anti-tuberculosis therapy was started for all the patients which was well tolerated. All patients are doing well at the time of the last follow up. This case series stresses the importance of having a high index of suspicion and preoperative biopsy in cases where imaging features are equivocal.
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Affiliation(s)
- Devayani Niyogi
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rajesh S Shinde
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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7
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Abstract
Tuberculosis of the liver, biliary tract, and pancreas is discussed. In addition, tuberculosis in the setting of HIV-AIDS and liver transplantation is explored. Drug-induced liver injury secondary to antituberculosis medication and monitoring and prophylactic treatment for such injury is also considered.
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8
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Gounder L, Moodley P, Drain PK, Hickey AJ, Moosa MYS. Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults. BMC Infect Dis 2017; 17:115. [PMID: 28148232 PMCID: PMC5288843 DOI: 10.1186/s12879-017-2222-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Lilishia Gounder
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
- Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa.
| | - Pravikrishnen Moodley
- Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa
| | - Paul K Drain
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
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Jain N, Rissam HK, Puri SK, Chauhan U. The "frosted liver" appearance in hepatic tuberculosis: a rare presentation. BJR Case Rep 2016; 2:20150367. [PMID: 30460020 PMCID: PMC6243321 DOI: 10.1259/bjrcr.20150367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/17/2016] [Accepted: 03/22/2016] [Indexed: 01/17/2023] Open
Abstract
Tuberculosis is a major re-emerging global health concern. The disease may involve any body system and is a great mimicker of various pathologies owing to its non-specific imaging findings. Herein we report an extremely rare case of atypical tuberculosis of the liver in a young female with complaints of abdominal pain and haematemesis for 10 weeks. Isolated hepatic tuberculosis is a rare entity with < 100 cases reported in the literature. It is therefore important to have a high index of suspicion and be familiar with the atypical imaging findings of abdominal tuberculosis. This discussion highlights the clinical presentation, imaging findings and types of hepatic involvement in tuberculosis.
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Affiliation(s)
- Neeraj Jain
- Department of Radio diagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Harmeet Kaur Rissam
- Department of Radio diagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sunil Kumar Puri
- Department of Radio diagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Udit Chauhan
- Department of Radio diagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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11
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Husain M, Khan S, Hassan MJ. Hepatic tuberculosis mimicking metastasis in a case of carcinoma sigmoid colon. J Lab Physicians 2015; 7:64-6. [PMID: 25949064 PMCID: PMC4411815 DOI: 10.4103/0974-2727.154802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis (TB) presenting as isolated liver mass without clinical evidence of TB is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver. Hepatic TB associated with carcinoma colon is a rare association which has very rarely been reported in the literature. This case illustrates the diagnostic difficulties of hepatic TB and the need to consider it in the differential diagnosis of hepatic nodular lesions in carcinoma colon patients. Here, we report a case of 48-year-old female who presented in the casualty with features of acute intestinal obstruction. Preoperatively a mass was seen at the hepatic flexure along with three lesions in the liver presumed to be metastatic in origin. However, histopathology of the mass revealed adenocarcinoma colon and the liver lesion proved to be hepatic TB. We wish to highlight that on encountering a hepatic lesion in a carcinoma colon patient the possibility of hepatic TB should also be kept in mind apart from the obvious possibility of metastasis especially in an endemic country like India.
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Affiliation(s)
- Musharraf Husain
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sabina Khan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mohammad Jaseem Hassan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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12
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Hickey AJ, Gounder L, Moosa MYS, Drain PK. A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC Infect Dis 2015; 15:209. [PMID: 25943103 PMCID: PMC4425874 DOI: 10.1186/s12879-015-0944-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 04/27/2015] [Indexed: 01/12/2023] Open
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.
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Affiliation(s)
- Andrew J Hickey
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
| | - Lilishia Gounder
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. .,Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Paul K Drain
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA. .,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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13
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Suthar PP, Bumiya RG, Patel K, Patel AB. Incidental diagnosis of liver tuberculosis in a patient with jaundice. BMJ Case Rep 2015; 2015:bcr-2014-206866. [PMID: 25733085 DOI: 10.1136/bcr-2014-206866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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.
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Affiliation(s)
| | - Raj G Bumiya
- Department of Radiodiagnosis, Medical College Baroda, Vadodara, Gujarat, India
| | - Kimmyben Patel
- SBKS Medical Institute and Research Centre, North Chesterfield, Virginia, USA
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14
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Puranik AD, Purandare NC, Sridhar E, Agrawal A, Shah S, Rangarajan V. Rare solitary focal tuberculous involvement of liver masquerading as hepatic metastasis on FDG PET/CT in a case of fibular round cell tumor. Indian J Nucl Med 2015; 30:65-7. [PMID: 25589811 PMCID: PMC4290071 DOI: 10.4103/0972-3919.147548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Finding of focal 18F-fluoro-deoxyglucose (FDG) uptake in liver on FDG positron emission tomography/computed tomography (FDG PET/CT) in a known case of malignancy is often considered to be metastases. We report a similar finding on FDG PET/CT in a case of Ewing's sarcoma of thigh, which turned out to be of tuberculous etiology, an unusual cause of false positive FDG uptake in the liver.
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Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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15
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Chen TC, Chou LT, Huang CC, Lai AB, Wang JH. Isolated tuberculous liver abscess in an immunocompetent adult patient: A case report and literature review. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 49:455-8. [PMID: 24231587 DOI: 10.1016/j.jmii.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 08/20/2013] [Accepted: 09/11/2013] [Indexed: 02/01/2023]
Abstract
Tuberculous liver abscess is a rare disease entity even in endemic areas of Mycobacterium tuberculosis. It is usually accompanied by pulmonary tuberculosis or enteric tuberculosis. Further, an isolated tuberculous liver abscess is extremely rare. The disease is diagnosed by laparotomy or postmortem autopsy in most cases, and some authors adopted a 9-month antituberculosis regimen. We herein report a case of an isolated tuberculous liver abscess that initially manifested as persistent fever and general malaise, which was diagnosed by liver biopsy and treated successfully with a 6-month antituberculosis regimen and percutaneous abscess drainage.
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Affiliation(s)
- Tsung-Chia Chen
- Division of Infectious Diseases, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Infection Control Committee, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Ling-Tai Chou
- Division of Gastroenterology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chen-Cheng Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - An-Bang Lai
- Department of Radiology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Jen-Hsien Wang
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
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16
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Kim TK, Choi CW, Ha JK, Jang HH, Park SB, Kim HW, Kang DH. [A case of tuberculous liver abscess developed during chemotherapy for tuberculous peritonitis as paradoxical response]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 62:64-8. [PMID: 23954963 DOI: 10.4166/kjg.2013.62.1.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diagnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.
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Affiliation(s)
- Tae Kyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
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17
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Nandan D, Bhatt GC, Dewan V, Yadav TP, Singh S. Isolated tuberculous liver abscess in a 3-year-old immunocompetent child. Paediatr Int Child Health 2013; 33:187-9. [PMID: 23930733 DOI: 10.1179/2046905512y.0000000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tuberculous liver abscess without active pulmonary or miliary tuberculosis or other clinical evidence of tuberculosis, is very rare. A 3-year-old immunocompetent boy with isolated tuberculous liver abscess recovered completely on systemic anti-tuberculous drugs.
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Affiliation(s)
- Devki Nandan
- Postgraduate Institute of Medical Education and Research and Associated Dr RML Hospital, New Delhi, India
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Hafezi Ahmadi M, Teimouri H, Alizadeh S. The liver Metastatic Adenocarcinoma of Colorectal Cancer With Synchronous Isolated Hepatic Tuberculosis. HEPATITIS MONTHLY 2013; 13:e9844. [PMID: 23967026 PMCID: PMC3741692 DOI: 10.5812/hepatmon.9844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/31/2012] [Indexed: 12/11/2022]
Affiliation(s)
| | - Hadi Teimouri
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Sajjad Alizadeh
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding author: Sajjad Alizadeh, Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-8413349474, Fax: +98-8412227136, E-mail:
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19
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Bhatt GC, Nandan D, Singh S. Isolated tuberculous liver abscess in immunocompetent children - report of two cases. Pathog Glob Health 2013; 107:35-7. [PMID: 23432862 PMCID: PMC4001601 DOI: 10.1179/2047773212y.0000000071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Isolated tuberculous liver abscess (TLA) without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare and only few cases have been reported in the literature. We report two cases of isolated TLA in immunocompetent children, treated successfully by percutaneous aspiration followed by systemic antituberculous drugs.
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Affiliation(s)
| | - Devki Nandan
- Department of Pediatrics, PGIMER & Associated Dr RML Hospital, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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20
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Mojtahedzadeh M, Otoukesh S, Shahsafi MR, Tahbaz MO, Rahvari SK, Poorabdollah M, Sajadi MM. Case report: portal hypertension secondary to isolated liver tuberculosis. Am J Trop Med Hyg 2012; 87:162-4. [PMID: 22764308 DOI: 10.4269/ajtmh.2012.11-0643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In this report, we present a case of isolated liver tuberculosis (TB) as a cause of non-cirrhotic portal hypertension leading to bleeding esophageal varices. Although TB has been known to cause portal hypertension in a variety of ways, this case was notable for the presence of periportal inflammation and granulomas, also seen in hepatic schistosomiasis. Herein, we discuss isolated liver TB and the differential diagnosis of non-cirrhotic portal hypertension. In endemic areas, TB should be considered in the differential diagnosis of non-cirrhotic portal hypertension.
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Affiliation(s)
- Mona Mojtahedzadeh
- Resettlement Unit of United Nation High Commissioner for Refugees, Tehran, Islamic Republic of Iran.
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21
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Lim KR, Kang MH, Kim TS, Moon KW, Ryu DR, Lee HY, Han SS. A Case of Multi-Organ Macronodular Tuberculosis. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.1.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyoung Ree Lim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Myung Ho Kang
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Tae-Suk Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki-Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dong Ryeol Ryu
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hui Young Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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22
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Hsieh TC, Wu YC, Hsu CN, Yang CF, Chiang IP, Hsieh CY, Sun SS, Kao CH. Hepatic Macronodular Tuberculoma Mimics Liver Metastasis in a Patient With Locoregional Advanced Tongue Cancer. J Clin Oncol 2011; 29:e641-3. [PMID: 21606414 DOI: 10.1200/jco.2011.34.9407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Te-Chun Hsieh
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | - Yu-Chin Wu
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | | | | | | | | | - Shung-Shung Sun
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
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23
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Abstract
The liver plays an important role in host defense against invasive microorganisms. The effect of microbial pathogens on the liver can vary greatly, presenting with a wide variety of manifestations from asymptomatic increases in aminotransaminases, acute liver failure, hepatic fibrosis, and cirrhosis. In evaluating the liver manifestations of a potential infectious pathogen, diagnosis of some of the less common infectious pathogens is dependent on a high level of suspicion and recognition of some of the key diagnostic clues. Successful diagnosis can only be accomplished through a careful history, including travel and exposures, physical examination, and appropriate microbiologic studies. This article reviews the involvement of the liver during systemic infections with organisms that are not considered to be primarily hepatotropic.
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Affiliation(s)
- Rohit Talwani
- Assistant Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Bruce L. Gilliam
- Associate Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Charles Howell
- Profesor of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
- Director of Hepatology Research University of Maryland School of Medicine, Baltimore, MD
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24
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Shin YM. [Hepatic tuberculosis presenting as a large liver mass]. THE KOREAN JOURNAL OF HEPATOLOGY 2010; 16:197-200. [PMID: 20606506 DOI: 10.3350/kjhep.2010.16.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Yong Moon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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25
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Hwang SW, Kim YJ, Cho EJ, Choi JK, Kim SH, Yoon JH, Kim CY, Lee HS. [Clinical features of hepatic tuberculosis in biopsy-proven cases]. THE KOREAN JOURNAL OF HEPATOLOGY 2009; 15:159-67. [PMID: 19581768 DOI: 10.3350/kjhep.2009.15.2.159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Sung Wook Hwang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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26
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Dursun I, Yikilmaz A, Poyrazoglu H, Soyuer I, Gunduz Z. Radiological findings of isolated hepatic tuberculosis in a child with tubulointerstitial nephritis-uveitis syndrome. Pediatr Radiol 2009; 39:302-5. [PMID: 19137283 DOI: 10.1007/s00247-008-1097-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 11/13/2008] [Accepted: 11/18/2008] [Indexed: 11/26/2022]
Abstract
Isolated hepatic tuberculosis is a rare manifestation of tuberculosis in children although its incidence has been increasing, especially in immunosuppressed patients. Imaging studies frequently present a diagnostic challenge, especially for the nodular form. Thus a high index of suspicion is required for diagnosis. On US, hepatic tuberculosis may rarely present as a macronodular form (also called pseudotumour or tuberculoma). We report a 15-year-old girl with multiple hepatic macronodular masses due to isolated hepatic tuberculosis.
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Affiliation(s)
- Ismail Dursun
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Bahçelievler Mah. Mevlana Cad. Kalyoncu Sitesi, A Blok 10:10, Talas-Kayseri, Kayseri, 38100, Turkey.
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27
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Isolated perihepatic tuberculosis: imaging findings. Clin Radiol 2009; 64:184-9. [DOI: 10.1016/j.crad.2008.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 08/10/2008] [Accepted: 08/20/2008] [Indexed: 11/19/2022]
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28
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Abstract
Hepatobiliary tuberculosis (HTB) is uncommon and can be difficult to diagnose. We present our experience with HTB (over a 10-year period). Fourteen patients were identified from a total of 1888 cases of tuberculosis (TB) infection during this period. Five patients had isolated organ involvement [hepatic (n=3) and biliary (n=2)], and 9 had multiorgan involvement [2 organs (n=7) and 3 organs (n=2)]. The overall annual incidence ranged from 0.0% to 1.05% of all TB infections. Common clinical presentations were weight loss (64%), loss of appetite (64%), abdominal pain (57.1%), fever (50%), jaundice (42.3%), and abdominal distension (14.3%). The median delay from symptom onset to presentation was 40.5 days (range, 7-730 days), and from first presentation to diagnosis was 15 days (range, 1-420 days). Malignancy was initially suspected in 86%. Chest radiographic changes consistent with pulmonary TB were seen in 29% (n=4). Two had active pulmonary TB. Adverse effects of treatment occurred in 42.9%, mainly drug-induced hepatitis and nonspecific gastrointestinal symptoms. Three patients with biliary involvement required long-term biliary stenting. The overall mortality was 14%. In conclusion, HTB is uncommon and is often associated with other organ involvement. Presentation is often delayed, which may lead to significant morbidity and mortality.
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29
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Parsak CK, Hanta I, Aslan A, Alabaz O. Isolated hepatic tuberculosis presenting as cystic-like and tumour-like mass lesions. Case Rep Gastroenterol 2008; 2:18-21. [PMID: 21490832 PMCID: PMC3075160 DOI: 10.1159/000113221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hepatic tuberculosis is a rare manifestation of extra-pulmonary tuberculosis. Hepatic tuberculous lesions are especially mimicking tumour-like mass or cystic lesions in the liver and so can be misdiagnosed with several diseases. Histopathological examination of the specimen is essential in the diagnosis for hepatic tuberculosis. In this report, two cases with hepatic tuberculosis having cystic solid mass and abscess liver lesions are described.
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Affiliation(s)
- Cem Kaan Parsak
- Department of General Surgery, Faculty of Medicine, Çukurova University, Balcali, Turkey
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30
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Ibanez Martin P, Fresard A, Cuilleron M, Peoc'h M, Patouillard B, Prost B, Audigier JC. [Pseudo-tumoral hepatic tuberculosis developing into a multinodular form despite treatment]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:605-8. [PMID: 16733386 DOI: 10.1016/s0399-8320(06)73235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Localized macronodular tuberculosis of the liver is rare. In this location antituberculosis therapy results in a favorable clinical evolution in 100% of cases. We report a pseudo-tumoral form of this condition with no specific clinical, biological or radiological data. After ultrasound guided needle aspiration cytology suggesting metastasis, the correct diagnosis was obtained on liver biopsy after laparotomy. After what was probably inadequate therapy, the enlargement of several hepatic and splenic macronodules was observed. After two years and eight months, the clinical condition of the patient was good but radiological features remained. The risk of diagnostic errors and the therapeutic difficulties in the zones where the incidence of tuberculosis is low should be noted.
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Affiliation(s)
- Pascale Ibanez Martin
- Service de Gastro-Entérologie et d'Hépatologie, Hôpital de Bellevue, CHU Saint-Etienne.
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31
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Turinelli V, Ledieu D, Guilbaud L, Marchal T, Magnol JP, Fournel-Fleury C. Mycobacterium tuberculosis infection in a dog from Africa. Vet Clin Pathol 2005; 33:177-81. [PMID: 15334356 DOI: 10.1111/j.1939-165x.2004.tb00371.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 4-year-old male Boxer dog with a history of vomiting, diarrhea, and weight loss moved from West Africa to Lyon, France, where it was further evaluated. Radiographs revealed pleural effusion and enlargement of tracheobronchial lymph nodes and liver. Cytologic examination of the pleural effusion and a fine needle aspirate specimen of the liver showed mixed mononuclear inflammation with nonstaining rod structures within epithelioid histiocytes. At necropsy, the main gross pathologic findings were exudative pleuritis, nodular hepatitis, and infarcts and caseous nodules in the kidneys. The main histologic lesions were granulomatous hepatitis, granulomatous pneumonia, fibrinous leukocytic pleuritis, necrotic and fibro-calcified granulomatous lymphadenitis, and granulomatous nephritis. A Ziehl-Neelsen stain applied to both cytologic and histologic samples was positive for acid-fast bacilli. Bacterial culture of the pleural fluid was positive for Mycobacterium tuberculosis. Cytology is a valuable tool in the diagnosis of this important zoonotic disease.
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Affiliation(s)
- V Turinelli
- Laboratoire d'Hématologie-Cytologie-Immunopathologie, Ecole Nationale Vétérinaire de Lyon, France.
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32
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Yu RS, Zhang SZ, Wu JJ, Li RF. Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol 2004; 10:1639-42. [PMID: 15162540 PMCID: PMC4572769 DOI: 10.3748/wjg.v10.i11.1639] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2003] [Revised: 10/04/2003] [Accepted: 10/22/2003] [Indexed: 12/15/2022] Open
Abstract
AIM To assess CT, MR manifestations and their diagnostic value in hepatic tuberculosis. METHODS CT findings in 12 cases and MR findings in 4 cases of hepatic tuberculosis proved by surgery or biopsy were retrospectively analyzed. RESULTS (1) CT findings: One case of serohepatic type of hepatic tuberculosis had multiple-nodular lesions in the subcapsule of liver. Parenchymal type was found in 10 cases, including multiple, miliary, micronodular and low-density lesions with miliary calcifications in 2 cases; singular, low-density mass with multiple flecked calcifications in 3 cases; multiple cystic lesions in 1 case; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or "cluster" sign in 3 cases; and singular, macronodular and low-density lesion with multiple miliary calcifications in 1 case. One case of tuberculous cholangitis showed marked dilated intrahepatic ducts with multiple flecked calcifications in the porta hepatis. (2) MR findings in 4 cases were hypointense on both T1-weighted imagings and T2-weighted imagings in one case, hypointense on T1-weighted imagings and hyperintense on T2-weighted imagings in 3 cases. Enhanced MR in 3 cases was slightly shown peripheral enhancement or with multilocular enhancement. CONCLUSION Various types of hepatic tuberculosis have different imaging findings, and typical CT and MR findings can suggest the diagnosis.
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Affiliation(s)
- Ri-Sheng Yu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
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33
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Hwang S, Simsir A, Waisman J, Moreira AL. Extrapulmonary tuberculosis as a mimicker of neoplasia. Diagn Cytopathol 2004; 30:82-7. [PMID: 14755756 DOI: 10.1002/dc.10416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite the efforts for control and eradication of tuberculosis, new cases of the disease are diagnosed daily. The diagnosis of tuberculosis is easily made when the classical features of pulmonary necrotizing granulomatous inflammation are seen. However, extrapulmonary lesions may clinically and radiographically mimic a neoplastic process, and this may lead to misdiagnosis and delay in treatment. We studied 6 patients by aspiration biopsy, all recent immigrants and immunocompetent, who presented with weight loss and fatigue. Of these, 5 patients had a mass. One patient presented with a lytic lesion of bone. In all cases the clinical diagnosis was neoplasia. In all aspirates, the smears showed necrotic debris with neutrophils. No neoplastic cells or granulomas were seen. All cases were signed out descriptively with no specific diagnosis. A search for acid-fast organisms leading to the correct diagnosis of tuberculosis was prompted by clinical investigations that revealed pulmonary lesions, or by repeat aspiration biopsy, which showed granulomatous inflammation. Tuberculosis when present in atypical forms is still a challenging diagnosis. The finding of necrotic debris in a needle biopsy without the clinical signs of an abscess should prompt a search for acid-fast bacilli, since the correct diagnosis will eliminate a needless surgical procedure and will lead to timely and appropriate therapy.
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Affiliation(s)
- S Hwang
- Department of Pathology, New York University School of Medicine, New York, NY 10016, USA
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34
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Verma A, Wade JJ. Non-viral infections of the liver. Indian J Pediatr 2002; 69:793-9. [PMID: 12420913 DOI: 10.1007/bf02723694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The function and anatomy of the liver renders this organ peculiarly susceptible to bacterial and parasitic infections; fungal infections are increasingly recognised in the immunocompromised. As biochemical abnormalities of liver function can be non-specific, a high index of suspicion of liver or biliary infection is required. A need for prompt investigation is emphasised by the potentially rapid progression and poor prognosis of some bacterial and fungal infections, and the public health implications of parasitic diseases. This review encompasses the major infections of the liver and biliary tree other than viral hepatitis and includes aspects of pathogenicity, epidemiology, clinical presentation, diagnosis and management.
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Affiliation(s)
- Anita Verma
- Department of Infection, King's College Hospital, London, UK
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