RESUMEN
The patient was an 81-year-old man. In his 20s, he had been treated with pharmacotherapy for pulmonary tuberculosis for 1 year. He presented to the Department of Respiratory Medicine with a chief complaint of dyspnea. The possibility of respiratory disease appeared to be low, but hepatic impairment was detected. The patient was thus referred to our department. Though the cause of hepatic impairment was unknown, the soluble interleukin-2 receptor level was elevated, suggesting malignant lymphoma. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) revealed diffuse, homogenous, intense FDG uptake in the entire liver, and transjugular liver biopsy confirmed the diagnosis. Histopathological examination revealed an epithelioid granuloma, and auramine staining was positive for bacilli suggestive of tuberculosis. CT revealed diffuse micronodular shadows in the lung, yielding a diagnosis of miliary tuberculosis. Therefore, the patient was prescribed antituberculosis medication by the Department of Respiratory Medicine. His subsequent clinical course was good. The miliary (hepatic) tuberculosis was typical based on the diffuse, homogenous, intense FDG uptake throughout the liver observed on PET-CT.
Asunto(s)
Fluorodesoxiglucosa F18 , Hígado , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Tuberculosis Miliar , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Anciano de 80 o más Años , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Hígado/patología , Hígado/diagnóstico por imagen , Biopsia/métodos , Antituberculosos/uso terapéutico , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/diagnósticoRESUMEN
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.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Absceso Hepático , Tuberculosis Hepática , Tuberculosis , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Humanos , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/tratamiento farmacológicoRESUMEN
BACKGROUND: Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems. CASE PRESENTATION: A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB. CONCLUSIONS: A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.
Asunto(s)
Adenocarcinoma , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Tuberculosis Hepática , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Antituberculosos/uso terapéutico , Neoplasias del Conducto Colédoco/patología , Neoplasias del Conducto Colédoco/cirugía , Humanos , Hallazgos Incidentales , Masculino , Pancreaticoduodenectomía , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , Tuberculosis Hepática/cirugíaRESUMEN
Tuberculosis of the stomach is quite rare, both as a primary or secondary infection. It has varied presentation ranging from non-specific abdominal pain and constitutional symptoms to hematemesis, gastric outlet obstruction and pyrexia of unknown origin. Here, we report a rare, interesting case of locally advanced gastric tuberculosis, which morphologically mimicked liver abscess initially in a young, immunocompetent patient presenting with fever and abdominal pain. The disease was diagnosed by GeneXpert MTB/RIF assay, and responded well to antituberculosis medication without surgery. Clinicians must bear in mind that, even in the absence of immunodeficiency, as in this case, tuberculosis can involve any site in the gastrointestinal tract and may present with a variety of presentation and infiltrating adjacent organ that might be mistaken as malignancy. This is first case report of gastric tuberculosis, which is locally advanced with adjacent liver infiltration initially thought to be left lobe liver abscess.
Asunto(s)
Absceso Hepático Amebiano/diagnóstico , Gastropatías/diagnóstico , Neoplasias Gástricas/diagnóstico , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Hepática/diagnóstico , Adenocarcinoma/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Gastroscopía , Humanos , Linfoma/diagnóstico , Masculino , Técnicas de Amplificación de Ácido Nucleico , Gastropatías/tratamiento farmacológico , Gastropatías/patología , Tomografía Computarizada por Rayos X , Tuberculosis Gastrointestinal/tratamiento farmacológico , Tuberculosis Gastrointestinal/patología , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , UltrasonografíaRESUMEN
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.
Asunto(s)
Antituberculosos/uso terapéutico , Biopsia , Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/tratamiento farmacológico , Adulto , Diabetes Mellitus Tipo 2 , Diagnóstico Diferencial , Humanos , Huésped Inmunocomprometido , Masculino , Síndrome MetabólicoRESUMEN
A 65-year-old woman underwent FDG PET/CT for presumed hepatosplenic malignancy suggested by an abdominal CT. The images revealed multiple foci of intense FDG activity in both the liver and the spleen. However, a splenic biopsy result revealed no malignant cells, and either tuberculosis or sarcoidosis was proposed. Following an incomplete antituberculosis therapy, a repeat FDG PET/CT showed resolution of the abnormal activity in the liver and the spleen.
Asunto(s)
Tomografía Computarizada por Tomografía de Emisión de Positrones , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Esplénica/diagnóstico por imagen , Anciano , Femenino , Fluorodesoxiglucosa F18 , Humanos , Radiofármacos , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológicoAsunto(s)
Adalimumab/efectos adversos , Antirreumáticos/efectos adversos , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Absceso Hepático/etiología , Tuberculosis Hepática/etiología , Tuberculosis Miliar/etiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/uso terapéutico , Adulto , Antirreumáticos/uso terapéutico , Antituberculosos/uso terapéutico , Sustitución de Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Huésped Inmunocomprometido , Tuberculosis Latente/complicaciones , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/tratamiento farmacológico , Mesalamina/uso terapéutico , Proctocolitis/complicaciones , Proctocolitis/tratamiento farmacológico , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Esplénica/diagnóstico por imagen , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/etiologíaRESUMEN
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.
Asunto(s)
Absceso Hepático/complicaciones , Tuberculosis Hepática/complicaciones , Tuberculosis Pleural/etiología , Adolescente , Antituberculosos/uso terapéutico , Drenaje , Femenino , Humanos , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/patología , Resultado del Tratamiento , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Pleural/patología , Tuberculosis Pleural/cirugíaRESUMEN
Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.
Asunto(s)
Antituberculosos/uso terapéutico , Neoplasias Hepáticas/diagnóstico , Tuberculosis Hepática/diagnóstico , Dolor Abdominal/etiología , Diagnóstico Diferencial , Neoplasias de la Vesícula Biliar/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Hepática/tratamiento farmacológico , Pérdida de PesoRESUMEN
Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.
Asunto(s)
Absceso Hepático/microbiología , Hígado/microbiología , Choque Séptico/etiología , Tuberculosis Hepática/microbiología , Adolescente , Antibióticos Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Inmunocompetencia , Hígado/diagnóstico por imagen , Hígado/patología , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/patología , Mycobacterium tuberculosis/aislamiento & purificación , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Hepática/tratamiento farmacológicoRESUMEN
Abdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumours. We report a case of 38 years old male presenting with abdominal pain, loss of appetite and weight initially misdiagnosed as intrahepatic cholangiocarcinoma on magnetic resonance imaging and FNAC of the lesion but later diagnosed as a case of hepatic tuberculosis on post operative histopathology specimen. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms.
Asunto(s)
Tuberculosis Hepática/diagnóstico , Adulto , Neoplasias de los Conductos Biliares/diagnóstico , Biopsia con Aguja Fina , Colangiocarcinoma/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patologíaRESUMEN
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.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico , Tuberculosis Hepática/diagnóstico , Adolescente , Antituberculosos/uso terapéutico , Enfermedades de las Vías Biliares/complicaciones , Enfermedades de las Vías Biliares/patología , Células Epitelioides/citología , Fatiga/etiología , Granuloma/patología , Humanos , Masculino , Necrosis , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , Pérdida de PesoRESUMEN
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.
Asunto(s)
Colestasis Intrahepática/etiología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/diagnóstico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Pancreatocolangiografía por Resonancia Magnética , Medios de Contraste , Femenino , Humanos , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Ganglionar/tratamiento farmacológico , UltrasonografíaRESUMEN
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.
Asunto(s)
Calcinosis/complicaciones , Calcinosis/diagnóstico , Enfermedades Linfáticas/complicaciones , Enfermedades Linfáticas/diagnóstico , Enfermedades Pancreáticas/complicaciones , Tuberculosis Hepática/complicaciones , Antituberculosos/uso terapéutico , Calcinosis/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Enfermedades Linfáticas/tratamiento farmacológico , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/tratamiento farmacológico , Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/tratamiento farmacológicoRESUMEN
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.
Asunto(s)
Enfermedades del Conducto Colédoco/diagnóstico , Tuberculosis Hepática/diagnóstico , Antituberculosos/uso terapéutico , Biopsia con Aguja Fina , Colestasis/etiología , Enfermedades del Conducto Colédoco/complicaciones , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/tratamiento farmacológico , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico , Diagnóstico Diferencial , Humanos , Ictericia/etiología , Masculino , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , Adulto JovenRESUMEN
Hepatobiliary system involvement is frequently seen as part of disseminated tubercular infection. But primary isolated hepatobiliary tuberculosis with no evidence of tuberculosis elsewhere in the body is extremely rare. Isolated hepatobiliary tuberculosis can cause diagnostic dilemma as the clinical, laboratory and imaging features are non-specific in majority of the cases. We report the case of a 50-year-old woman who presented with hepatobiliary tuberculosis with no pulmonary or extra hepatic involvement. Liver function tests were abnormal and ultrasonography (USG), CT and MR cholangiopancreatography showed multiple focal lesions in the liver. The diagnosis of tuberculosis was confirmed by a USG-guided biopsy of the liver lesions. In endemic regions with the presence of supportive imaging findings, in the appropriate clinical setting, the possibility of hepatic tuberculosis should be considered and diagnosis has to be confirmed with histopathological examination.
Asunto(s)
Antituberculosos/uso terapéutico , Fiebre/microbiología , Tuberculosis Hepática/diagnóstico por imagen , Femenino , Humanos , Biopsia Guiada por Imagen , Pruebas de Función Hepática , Persona de Mediana Edad , Resultado del Tratamiento , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/microbiología , Ultrasonografía Intervencional , Pérdida de PesoRESUMEN
Isolated macro-nodular liver tuberculosis is a very rare condition. It may mimic primitive or secondary tumors of the liver. This could delay or mislead the therapeutic management. An immunocompetent 48-year-old man with a history of non-metastatic seminoma was treated with right orchidectomy followed by 20 Gy radiotherapy. The discovery, 8 months later, of a 2 cm nodule of the hepatic dome evoked a liver metastasis. Percutaneous biopsy was not feasible. Wedge resection was performed whereas medical treatment would have sufficed, as pathologic examination of the resected specimen showed a macro-nodular hepatic tuberculosis. The patient received anti-tuberculosis drugs for 9 months. The diagnosis of isolated macro-nodular liver tuberculosis is frequently misleading, particularly in immunocompetent and paucisymptomatic patients. Thus percutaneous biopsy is mandatory for diagnosis and also prior to any major surgeries.
Asunto(s)
Hígado/patología , Seminoma/patología , Neoplasias Testiculares/patología , Tuberculosis Hepática/diagnóstico , Antituberculosos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas , Masculino , Persona de Mediana Edad , Seminoma/terapia , Neoplasias Testiculares/terapia , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/tratamiento farmacológicoRESUMEN
For many years, tuberculosis (TB) has been endemic in Pakistan; many rare and unusual presentations have been reported. There is a myriad of non-specific symptoms which always requires a high index of clinical suspicion for TB. World Health Organization data suggest that Pakistan ranks as the fifth highest country burdened with TB and has the fourth highest prevalence of multi-drug resistant TB globally. With an annual incidence of 277 cases per 100,000, the importance of early diagnosis and treatment is self-evident. We present a case where a strong suspicion of isolated hepatosplenic TB in an immunocompetent patient justified a directed approach.