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PubMedDate not supplied

[Hepatic tuberculosis].

Hepatic tuberculosis is well-known anatomicopathologically, consequent to necropsy and liver biopsy puncture, but the clinical aspect when the signs of the pulmonary localization are not dominant, may be similar to other "masked" affections, hepatic or extrahepatic, more often chronic hepatitis, hepatic tumours or prolonged febrile syndrome with many etiologic possibilities. The past history of the patients is very important as it confirms the observation of the histopathologic and possibly bacteriological examinations of a liver fragment. Three cases presumptively clinically diagnosed are presented and histopathologically verified for confirmation of the facts illustrated.

Adult↗
PubMed1990

Hepatic tuberculosis; a rare case of bleeding gastric varices.

A laparotomy was performed on a 68-year-old female who, in spite of medical treatment, suffered from uncontrolled upper gastrointestinal bleeding due to ruptured gastric varices. Histological examination of the liver tissue taken during operation revealed tuberculosis. Hepatic tuberculosis, although rare, should be kept in mind as one of the differential diagnosis when there is unexplained, noncirrhotic bleeding gastric varices.

Aged↗
PubMed1984

Tuberculosis hepatitis: a clinical review of 96 cases.

Hepatic tuberculosis was confirmed in 96 patients presenting with the features of liver disease, only 14 of whom had other concomitant hepatic pathology. Although respiratory symptoms occurred in 74 per cent of cases, these were overshadowed by the abdominal manifestations. The latter most frequently included right hypochondrial pain, abdominal distension, firm tender hepatomegaly, splenomegaly and ascites. Icterus was observed in 11 cases (only one of whom had concurrent hepatic pathology) and liver failure was found in 10 patients. A surgical presentation occurred in three patients. Four of 15 patients with pancytopenia were noted to have hypersplenism. Abnormalities in coagulation were noted in 26 patients (24 with low prothrombin index and two with moderately raised fibrinogen degradation products). The characteristic serum profile included hyponatraemia (64 per cent of cases), raised alkaline phosphatase (83 per cent) and gamma glutamyl transferase (77 per cent), hypoalbuminaemia (63 per cent) and hypergammaglobulinaemia (83 per cent). Transaminase levels were moderately elevated in 78 per cent of cases. Hepatic imaging techniques were frequently misleading. Chest radiographs aided the diagnosis but were normal in 25 per cent of cases. Histologically, acid fast bacilli, caseation and granulomas were seen in 9, 83 and 96 per cent of cases respectively. Adverse prognostic features included age (below 20 years), miliary TB, coagulation defects and the presence of predisposing factors; these were of value in selecting appropriate therapy. The overall mortality was 42 per cent. Liver biopsy was the most useful aid to correct diagnosis which was suspected clinically in only 47 per cent of cases.

Adolescent↗
PubMed1986

Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature.

Local hepatic tuberculosis is an unusual form of extrapulmonary tuberculosis. The authors describe the case of a 39-year-old woman with this disease who posed diagnostic difficulties. She presented with abdominal pain, minimal constitutional symptoms, hepatomegaly and radiologic findings of a focal hepatic lesion. Laparotomy was required for diagnosis. A literature review revealed that most individuals with local hepatic tuberculosis have fever, night sweats and weight loss. Hepatomegaly is often the only abnormal physical sign. Minimally elevated serum bilirubin and alkaline phosphatase levels are common. Ultrasonography and computerized tomography will demonstrate a lobulated, hypoechoic liver mass. Definitive diagnosis requires demonstration of acid-fast bacilli in biopsy material obtained by percutaneous techniques or at laparotomy. Cultures of the diseased liver are usually negative. Antituberculous drug therapy appears to be the preferred method of treatment.

Abdomen↗
PubMed1996

[Pseudotumorous hepatic tuberculosis: laparoscopic appearance].

Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.

Aged↗
PubMed1995

[Clinical characteristics of hepatic tuberculosis].

The clinical characteristics of hepatic tuberculosis in 52 cases diagnosed pathologically were analyzed. Fever, abdominal pain and hepatomegaly were the major clinical manifestations; they were present in 96.2%, 42.3% and 88.5% of the patients respectively. The fever had no consistent pattern and the abdominal pain was usually localized to the right hypochondrium and not related to overwork. Hypergrammaglobulinaemia, elevated alkaline phosphatase level and increased ESR were noted in most of the patients (76.9%, 75.0%, 76.5% respectively). 62.5% of the 52 patients was diagnosed by percutaneous liver biopsy. Since there is no consistent clinical pattern in patients with hepatic tuberculosis, the diagnosis should be considered in patients with unexplained fever associated especially with hepatomegaly or hepatosplenomegaly, elevated alkaline phosphatase level, hypergrammaglobulinaemia and increased ESR, Liver biopsy is the most valuable method to confirm the diagnosis of hepatic tuberculosis.

Adolescent↗
PubMed1990

The nodular form of local hepatic tuberculosis. A review.

Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of tuberculoma or tuberculous liver abscess without clinical evidence of tuberculosis elsewhere. Since 1950, 21 cases of isolated tuberculoma or tuberculous abscess of the liver have been reported in the world literature. We report an additional two cases, one tuberculoma and one with multiple tuberculous abscesses. The case reports illustrate the difficulty in reaching the correct diagnosis, unsuspected in nearly all cases and most often confused with carcinoma of the liver. The correct diagnosis was made by histology, identification of acid-fast organisms by smear, and by cultures of Mycobacterium tuberculosis, but required laparotomy in 19 of the 23 cases. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the vast majority of patients respond well to antituberculous chemotherapy.

Adolescent↗
PubMed2003

Clinical spectrum of hepatic tuberculosis: comparison between immunocompetent and immunocompromised hosts.

BACKGROUND: Hepatic tuberculosis has been reported in normal and immunocompromised hosts. However, no published comparisons between these two groups of subjects with hepatic tuberculosis have been found. The aim of this study was to compare the clinical manifestations, biochemical tests, radiologic features and pathological findings of hepatic tuberculosis in immunocompromised and immunocompetent patients. METHOD: The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted between January 1993 and October 2000 to Chulalongkorn University Hospital, Thailand. There were 12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE) male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations, biochemical tests, radiologic features and pathological findings were compared between these 2 groups. The diagnosis of Mycobacterium tuberculosis (M. tb) was the combination of a demonstrated organism in hemo- or specimen culture, histopathology (positive acid fast bacilli) and rapid identification of M. tb from nested polymerase chain reaction (nPCR) assay based on amplification of the IS 6110 insertion sequences. RESULTS: The clinical features were similar in both groups with fever, weight loss and hepatomegaly as the main manifestations. The biochemical findings were also similar but the alkaline phosphatase (ALP) was significantly higher in the immunocompromised group (p < 0.001). Hepatomegaly and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found more commonly in the immunocompetent subjects, although the differences were not statistically significant. Non-caseating granuloma without detection of acid fast bacilli was a common finding in both groups. The nested PCR assay increased the sensitivity from 49 per cent to 86 per cent compared to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was significantly higher in immunocompetent patients (p < 0.05) due to the extreme age and severe coexisting diseases. CONCLUSION: Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and reverse A/G ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was significantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and specificity in the diagnosis of this disease.

Adolescent↗
PubMed2004

Imaging diagnosis of 12 patients with hepatic tuberculosis.

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.

Adolescent↗