Primary hepatic tuberculosis: A rare occurrence

Hepato-pancreato-biliary tuberculosis: A review

Hepato-pancreato-biliary (HPB) tuberculosis (TB) is a rare form of extra-pulmonary TB that poses a diagnostic dilemma and is a great masquerader of malignancy. It is almost always curable but requires a high degree of suspicion and corroboratory evidence to document its existence. Medline/PubMed was searched with keywords "hepatic", "liver", "biliary" and "pancreatic" with "tuberculosis". Data were gathered and analyzed. Common symptoms of HPB TB include jaundice, weight loss, abdominal pain and other constitutional symptoms that make it indistinguishable from malignancy. Imaging modalities such as ultrasonography, computed tomography, magnetic resonance imaging may reveal dilated intrahepatic biliary radicles, mass lesion, and biliary stricture or enlarged necrotic lymph nodes. Fine-needle aspiration cytology/biopsy, brush biopsy, acid-fast bacilli (AFB) staining and molecular testing may help clinch the diagnosis. Most cases require biliary drainage and initiation of anti-tubercular therapy (ATT) whereas surgery is reserved for medically refractory cases or fibrotic strictures. However, most cases are diagnosed post-operatively on histopathology where pre-operative diagnosis is malignancy. A high index of suspicion, coupled with streamlined investigations, may help identify patients pre-operatively to be managed with ATT as TB is completely curable with medical management in most of the cases.

Case report: Hepatic tuberculosis mimicking hepatocellular carcinoma in a patient with cirrhosis induced by hepatitis B virus

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.

Mycobacterium tuberculosis SIT42 Infection in an Abused Dog in Southern Italy

A case of Mycobacterium tuberculosis infection is described in a dead adult male dog in Southern Italy. The carcass was found by the Health Authority in a gypsy encampment. It was admitted to our forensic veterinary medicine unit, with a suspicion of cruelty to the animal. Necropsy showed beating and traumatism signs, and mistreating was confirmed. Gross lesions included multiple nodular hepatic lesions, hemorrhagic enteritis with enlarged mesenteric lymph nodes, body cavity effusions, and an adrenal neoplasm. Bacteriological and molecular analyses were carried out on the liver lesions that enabled to identify M. tuberculosis SIT42 (LAM9). Drug-resistance patterns were evaluated by screening mutations on the rpoB and katG genes that showed susceptibility to both rifampin and isoniazid, respectively. Very few studies report canine tuberculosis, and little is known about the disease in Italy. To the authors' knowledge, this is the first report of Mycobacterium tuberculosis SIT42 infection in a dog in Italy.

Liver segmentectomy surgery for delayed diagnosed hepatic TB, a case report from Syria

Introduction and importance: Mycobacterium Tuberculosis infection is still one of the most common causes of morbidity and mortality worldwide. TB usually infects the lungs, but it can affect other organs. Hepatic involvement usually occurs with disseminated disease whereas isolated hepatic involvement is extremely rare. Case presentation: We present a case of a female patient who had to undergo major hepatic surgery due to delayed diagnosis of hepatic TB. It suffered from recurrent abdominal abscesses and general symptoms for a period of time. clinical Discussion: Medical therapy is the treatment of choice and surgery is justified only in specific cases. Surgical intervention may range from less complicated procedures as local excision, abscess drainage or biliary drainage to more complicated and major surgeries such as liver segmentectomy and hemihepatectomy. conclusion: Although rare, physicians should suspect and diagnose early, to give the patient the best chance to benefit from medical therapy and avoid the need for surgical intervention.

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Although rare, hepatic TB still occurs with no specific symptoms or imaging study making it challenging.

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Surgical intervention may range from less complicated procedures to more complicated and major surgeries.

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The delayed decision to refer to a tertiary hospital for other options of treatment made her quality of life poor.

Hepatic tuberculosis masquerading as cholangiocarcinoma: an unusual differential for a liver mass

A 54-year-old woman presented with an incidentally identified asymptomatic liver lesion with imaging characteristics suspicious for malignancy. She underwent a left hemihepatectomy for presumed cholangiocarcinoma. Histopathology revealed granulomas with microbiological investigations later revealing a diagnosis of isolated hepatic tuberculosis. There were no pulmonary or other disease sites identified. The patient has been medically managed for primary hepatic tuberculosis and remains well postoperatively. This case identifies a rare differential for a liver mass that needs to be considered in the clinicians’ workup.

Looking beyond appearances: when liver biopsy is the key for hepatic tuberculosis diagnosis

Primary hepatic tuberculosis is a rare clinical entity with non-specific clinical and imaging features that can mimic other liver diseases, representing a diagnostic challenge. We report a case of a 35-year-old man with metabolic syndrome, type 2 diabetes and high alcohol consumption presenting asymptomatic with abnormal liver tests, hepatosplenomegaly and diffuse hepatic steatosis in ultrasound imaging initially suspected to be alcoholic steatohepatitis but later diagnosed as hepatic tuberculosis in the histological specimen. Anti-tuberculosis therapy was started. This clinical case highlights the diagnostic difficulty of hepatic tuberculosis and the importance of not overlooking liver biopsy and to consider it in the differential diagnosis in patients with obvious hepatic injury factors but with atypical clinical presentation.