Tuberculous liver abscess not associated with lung involvement

Hepatic tuberculosis is one of the uncommon forms of extrapulmonary tuberculosis. We report a 78-year-old woman who developed tuberculous liver abscesses with splenic abscess not associated with pulmonary foci. Ultrasonography and computed tomography of the abdomen showed the low-density lesions in the liver and spleen. Histopathology of specimens obtained by percutaneous needle biopsy revealed coagulation necrosis and epithelioid cells but not tumor cells, suggesting tuberculosis infection in the liver and spleen. Systemic chemotherapy with anti-tuberculous agents led to the improvement of the lesions in the liver as well as spleen. Although tuberculous liver abscess is a very rare case, it should be included in the differential diagnosis of unknown hepatic mass lesions.     

Isolated tuberculous liver abscesses with multiple hyperechoic masses on ultrasound: a case report and review of the literature

Abstract: Cases of isolated tuberculous liver abscess are rare. The diagnosis is often delayed or missed because of nonspecific symptoms and the disease's rare occurrence. Less than 25 cases have been documented in the imaging literature to date. This report demonstrates the difficulty in correctly diagnosing local hepatic tuberculosis. We report the case of a 56‐year‐old male with hepatitis C‐related liver cirrhosis and end‐stage renal disease treated with hemodialysis, who developed intermittent fever and hepatomegaly with unusual multiple hyperechoic hepatic lesions on ultrasound. To our knowledge, this is only the second reported case of hyperechoic mass‐like hepatic lesions on ultrasound and the only case without pulmonary involvement. A greater awareness of this rare clinical entity may prevent needless surgical interventions, because the prognosis of hepatic tuberculous abscess is good for the majority of patients if diagnosed early and prompt, effective treatment is administered.     

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.     

Tuberculous liver abscess in an immigrant patient with pulmonary tuberculosis

Liver abscess due to Mycobacterium tuberculosis associated with pulmonary tuberculosis is a rare diagnosis, particularly in patients without AIDS. We report the case of a male immigrant with no HIV infection who developed a tuberculous liver abscess and pulmonary tuberculosis simultaneously. Ziehl-Neelsen stain, PCR and L?wenstein-Jensen culture of material sampled from the abscess established the microbiological diagnosis. The patient's course was good, with disappearance of symptoms and the abscess after tuberculostatic treatment and drainage of the abscess with monitoring by computed tomography.     

Primary macronodular hepatic tuberculosis: US and CT appearances

Tuberculosis of the liver is uncommon except in association with miliary dissemination. Although hepatic involvement by tuberculosis tends to be diffuse, the macronodular or pseudotumor forms are rare. In addition, reports of actual imaging of tuberculous liver involvement are rare. A 5-year-old boy with a febrile illness due to macronodular hepatic tuberculosis, demonstrated by abdominal computed tomography (CT), and diagnosed by liver biopsy is presented.     

Pseudotumoral hepatic tuberculosis. Atypical presentation and comprehensive review of the literature.

We describe a 40-year-old black North American woman with isolated hepatic tuberculosis and an incidentally elevated alkaline phosphatase. Imaging studies of the liver showed a lesion suggesting primary or metastatic disease, which turned out to be the so-called pseudotumoral form of hepatic tuberculosis. We believe this is the first case recorded in the English language literature of isolated hepatic tuberculosis manifesting first as an incidentally elevated alkaline phosphatase. It seems to be the third documented case in the English literature of a patient with this rare form of tuberculous involvement without systemic manifestations. The patient responded to antituberculous therapy and is healthy 4 years after treatment.     

Tuberculous retropharyngeal abscess without cervical spine TB

Tuberculous retropharyngeal abscess is a rare presentation. It is present in adults usually due to involvement of cervical spine by tuberculosis. Retropharyngeal space usually gets involved in children due to pyogenic organisms or secondary to trauma. Here is a case of tuberculous retropharyngeal abscess in an adult female, with pulmonary tuberculosis. The patient was not having tuberculous involvement of cervical spine and was managed surgically by aspirating the retropharyngeal abscess transorally and AKT Category I.     

Parietal thoracic tuberculosis in the absence of immunosuppression by HIV infection

Parietal thoracic abscess formation of a tuberculous nature is a rare form of extrapulmonary tuberculosis, usually described in cases of severe tuberculosis encountered in HIV-infected patients. We report 13 cases of parietal tuberculosis in patients without HIV infection who were investigated between October 1988 and December 1999. During this period, we cared for 2 663 patients with tuberculosis. The series included 9 women and 4 men age 17 to 60 years, mean age 39 years. The clinical aspect of the parietal abscess was variable. Cold fluctuating abscess was dominant in 10 cases. In 3 cases, the parietal abscess had a hard consistence simulating a malignant tumor. The parietal abscess was in a posteriosuperior or posteriobasal location in 4 cases, and in an anterosuperior, anterobasal or axillary location in 6. Multiple thoracic abscesses were observed in only 3 cases. The size of the abscess varied from 2 to 2.5 cm. Radiologically, rib damage was present in 4 cases, scapular damage in 1, with bone lysis in 3 cases. Other localizations of tuberculosis were observed in 4 cases. one patient had multiple peripheral node enlargement, another had parenchymal lung damage and a third had a vertebral localization. Culture of abscess pus provided the diagnosis in 10 cases. the diagnosis was confirmed by pathology in 8 cases on a biopsy of the abscess border. Anti-tuberculosis drugs allowed successful recovery in all patients. We analyzed the clinical aspects of cold thoracic abscesses and discuss differential diagnosis. Early diagnosis and treatment is essential.     

Isolated hepatic tuberculosis: report of five cases and review of the literature

Tuberculosis is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Involvement of the liver alone by tuberculosis is, however, uncommon. It usually presents as a protracted illness frequently associated with jaundice and hepatomegaly. It can, therefore, mimic primary or metastatic liver malignancies. We report five cases of isolated hepatic tuberculosis, emphasizing the importance of obtaining a tissue diagnosis in all subjects with suspicious liver lesions to avoid missing the uncommon but curable hepatic tuberculosis.     

Case of tuberculous psoas abscess successfully treated with surgery during antituberculosis therapy for miliary tuberculosis

A case of tuberculous psoas abscess complicated during antituberculosis therapy for miliary tuberculosis and successfully treated with surgery was reported. A 20-year-old man visited our hospital because of fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however, miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis therapy was initiated with isoniazid, rifampicin, streptomycin, and pyrazinamide, the fever subsided. In spite of improvement of general radiographic findings, a new abscess was found in the right psoas major muscle after 8 months of therapy by computed tomography. A sample of the abscess showed a positive smear, negative culture, and positive PCR test for M. tuberculosis. Although antituberculosis therapy continued for another 6 months, the abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and curettage of the abscess was performed. Intra- and post-operative specimens were negative for bacteria, fungi, and M. tuberculosis. The patient was treated with isoniazid, rifampicin, and ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2.5 years after surgery.     

Tuberculosis or hepatic granulomatosis? (author's transl)

The authors report 43 observations of pulmonary or extra-pulmonary tuberculosis, bacteriologically proved, in which liver biopsies revealed more or less complete granulomatous lesions. The culture of 29 liver fragments on L?wenstein and Colestos medium enabled the identification of the tuberculous bacillum in only one case. In the other cases the hepatic lesion has only been related to the tuberculosis because of the clinical and bacteriological context. Therefore, besides exceptional cases where Koch bacillum is revealed in the liver parenchyma, it seems that granulomatosis can be considered a control for the delayed hypersensitivity reaction to the tuberculous antigens, and not to the tuberculous infection localized to liver.     

Clinico-immunological profile in a case of hepatic tubercular abscess: A rare manifestation of extrapulmonary TB in an immunocompetent child

Tubercular liver abscess is a rare entity even in an endemic area for TB. We report here a rare case of pediatric tuberculous liver abscess, the etiology of which was established using recently introduced Cartridge based nucleic acid amplification test (CBNAAT). A 7 years old male child presented with vomiting, pain abdomen and fever. Hepatomegaly was found on examination. Ultrasound of abdomen revealed two liver abscesses in the right lobe. Patient remained symptomatic even after empirical antimicrobial therapy. On diagnostic tap Gram stained smear of the pus showed polymorphs with negative culture. CBNAAT was positive for Mycobacterial tuberculosis and sensitive to rifampicin. Subjecting difficult extrapulmonary specimens to relevant microbiological investigations along with CBNAAT and other newer methods may improve diagnosis of tuberculosis in such rare cases thus leading to an early management and decrease in morbidity.     

Left lumbar subcutaneous cold abscess with tuberculous spondylitis

We report a 29-year-old man with a rare left lumbar subcutaneous cold abscess complicated by tuberculous spondylitis during the treatment of pulmonary tuberculosis. Pulmonary tuberculosis was rapidly improved by anti-tuberculous drugs, however curative operation for tuberculous spondylitis was necessary after 18 months because tuberculous spondylitis was overlooked. Imaging techniques are important in helping to establish a diagnosis of tuberculous spondylitis. It should be stressed that a high clinical index of suspicion for tuberculosis is needed to correctly diagnose this disease.     

Hepatobiliary tuberculosis

Tuberculous involvement of the liver as part of generalized military tuberculosis is well known. It is said to be found in 50-80% of all cases dying from pulmonary tuberculosis (1). However, localized tuberculosis of the liver as a clinical entity and producing large nodules or abscesses have been considered exceedingly rare, even in areas where tuberculosis is relatively common. Leader (2), in an extensive review of the world literature in 1952, documented only 80 cases of hepatic tuberculosis with large abscesses or nodules. Other publications deal with localized tuberculous involvement of the hepatobiliary tract in isolated case reports (1-8). In order to learn more about the clinical manifestation and course of this disease, we therefore prospectively evaluated our total experience on hepatobiliary tuberculosis during the last two decades of our practice.     

食管结核合并结核性腹膜炎1例

食管结核是结核杆菌侵及食管壁导致的一种少见的炎性肉芽肿性病变,其发病率低,易误诊.最容易混淆的疾病是食管癌和食管平滑肌瘤.食管结核常见症状为吞咽困难,胸骨后疼痛,消瘦和发热等,这些症状与食管平滑肌瘤、食管癌比较无特异性,术前诊断较困难.尤其是食管结核合并结合性腹膜炎更是少见.本文报道1例食管结核合并结核性腹膜炎,并结合文献,就诊断及治疗进行复习.     

Tubercular biliary hilar stricture: A rare case report

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.     

Pulmonary tuberculosis presenting as tubercular lupus

Pulmonary tuberculosis can be associated with skin manifestations. We report a case in which cutaneous tuberculous lesions were associated with asymptomatic pulmonary tuberculosis. A 15-year old woman had four cutaneous tumoral lesions on her face back, a few of which had evolved over a period of several years. They were asymptomatic nodular lesions, with rounded bumps, with, in places, cheloidal features. The biopsy specimen revealed non-caseating epithelioid granulomas with giant cells and the culture grew Mycobacterium tuberculosis. Cavitating pulmonary tuberculosis was then revealed by CT scan and acid-fast bacilli were isolated in her sputum. The skin lesions disappeared with anti-tuberculosis therapy. Cutaneous manifestations of tuberculosis are rare, polymorphous, and can be associated with an underlying visceral infection. Lupus vulgaris is the most common cutaneous manifestation of tuberculosis in industrialised countries, but nevertheless it remains rare and it is a very unusual presenting feature of underlying pulmonary tuberculosis.     

Tuberculous liver abscess: a case report and review of literature

Tuberculous liver abscess is rare worldwide. We report a 45-year-old man who presented with abdominal pain, fever and weight loss. Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver. Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli. The abscess was drained under ultrasound guidance. Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management. A greater awareness of this clinical entity is required for successful treatment.     

结核性肛周脓肿延误诊断临床分析(附5例报告)

2015年12月至2017年12月,航空总医院普外科收治的320例肛周脓肿患者中5例患者术后30d内切口未愈合,最终诊断为结核性肛周脓肿;其中3例并发肺结核,给予2R-H-E-Z/4R-H-E抗结核药物化疗方案治疗后,切口均愈合,平均愈合时间(25.5±3.6)d,无复发。分析延误诊断原因主要为:结核性肛周脓肿临床较少见,临床表现缺乏特异性,医务人员对此病的认识不足,未对患者病史进行详细分析,未进行脓液抗酸杆菌检查及肛周病变组织病理学检查。对于肛周脓肿的患者,应仔细询问患者病史,常规进行脓液分泌物抗酸杆菌检查、组织病理学检查。确诊为结核性肛周脓肿后应给予规范抗结核药物化疗方案治疗6个月至1年。     

Primary hepatic actinomycosis concomitant with elevation of protein induced by vitamin K absence or antagonist II - report of a case

We report a case of primary hepatic actinomycosis showing elevation of serum protein induced by vitamin K absence or antagonist II (PIVKA-II). A 68-year-old man visited an affiliated hospital with a complaint of high fever and body weight loss. Hematological examination revealed severe inflammatory reactions and liver dysfunction. Abdominal CT showed a heterogeneous low density area composed of cystic and solid part. We suspected the cystic part with band-like enhancement to be a hepatic abscess and performed percutaneous transhepatic abscess drainage. Although inflammatory reactions decreased after the drainage, the solid part did not shrink and blood chemistry revealed elevation of PIVKA-II. Since we could not rule out the possibility of hepatoma, right hepatectomy was performed. Histological examination revealed actinomycetes. Although primary hepatic actinomycosis is a rare disease, it must be kept in mind in the differential diagnosis of the liver tumor.