Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.     

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.     

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.     

Chest wall tuberculoma with tumor-like appearance

We report a rare case of chest tuberculoma with tumor-like appearance of which diagnosis was made by surgery. A 40-year-old woman presented to our hospital with a complaint of a right chest mass. Her past history was pulmonary tuberculosis. One year prior to this presentation, she was treated. Chest MRI revealed a solid and oval mass in the right lateral chest wall. Then, surgical resection was performed. Histopathological examinations revealed caseous necrosis, epithelioid cell granuloma, and multinucleated Langhans' giant cells, but no neoplastic cell was found. We confirmed that the mass was clinically compatible with tuberculoma. The characteristic presentation of the chest wall tuberculosis is abscess, which is frequently cystic, doughy, or soft. However, there is no report with chest wall tuberculoma as the initial presentation of tuberculous lesion arising in chest wall in a review of the English literature.     

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.     

Localisations inhabituelles de la tuberculose : à propos de trois observations

We report three cases of tuberculosis of unusual location in Malagasy patients. The first patient presented with intracardiac tuberculoma during pulmonary tuberculosis. The second patient who had no significant musculoskeletal past medical history presented with tuberculous polymyositis. The remaining one presented with tuberculous epididymitis without involvement of the urinary tract. Diagnosis was histopathological. The outcome was favorable in the two last patients with antituberculous therapy. This report emphasizes the necessary awareness of tuberculosis even in the presence of unusual manifestations in hyper-endemic area of tuberculosis.     

Liver abscess in the tropics: an experience from Nepal

Thirty-six consecutive cases of liver abscess seen at the BP Koirala Institute of Health Sciences Hospital, Dharan, Nepal, from 1995 to 1998, were reviewed. Twenty-one cases were male and 15 female, with a mean age of 42 years. Twenty-four cases (66.7%) were amebic, 7 (19.4%) pyogenic, 3 (8.3%) indeterminate and 2 (5.5%) tuberculous. The most frequent clinical features included fever (88%), leukocytosis (66.7%), abnormal level of serum albumin (44.4%) and alkaline phosphatase (38.9%). The liver abscess was single in 61.1%, multiple in 27.8%, and in 66.7% of cases the abscess was present in the right lobe of the liver. Ultrasonography was diagnostic in all cases. A positive culture of the abscess was obtained in 7 cases (19.4%). The most frequent bacteria found were Klebsiella pneumoniae (4;11.1%), followed by Escherichia coli (3;8.3%). Two cases were due to Mycobacterium tuberculosis and none had malignancy. Percutaneous drainage was performed in 27 patients (75%). Mortality attributable to the abscess was 5.5%. We found percutaneous needle aspiration of liver abscess helpful in confirming diagnosis, as it provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculosis. These two conditions should certainly be considered possible causes in our part of the world when an abscess fails to respond to standard treatment. In developing countries like Nepal, the clinical presentation of liver abscess has not varied over time. At present, rapid diagnosis and image-guided percutaneous drainage offer a better prognosis for liver abscess. We also recommend routine cytological examination of aspirated abscess materials, as well as stains and cultures for acid-fast bacilli.     

CT findings of six cases with intracranial tuberculosis in National Higashi-Saitama Hospital]

We have experienced 6 cases of intracranial tuberculosis since 1985. 2 cases were diagnosed as intracranial tuberculoma without tuberculous meningitis, and 4 cases were diagnosed as tuberculous meningitis. Brain CT showed intracranial tuberculomas in three of them, and showed cerebral infarcts in two cases, and showed hydrocephalus in two cases. Brain CT on intracranial tuberculosis showed various findings. In two cases with tuberculous meningitis, brain CT showed many tuberculomas with ringed or nodular enhancement appeared after adequate chemotherapy had been started. About 1 year later, a few tuberculomas were found with homogeneous enhancement and were enlarged while the chemotherapy was continued. But later they were reduced in size. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate anti-tuberculous chemotherapy during a course of tuberculous meningitis. They also suggest that the continuation of adequate chemotherapy might be necessary to the treatment of intracranial tuberculomas.     

The complication with tuberculosis of the central nervous system in patients with miliary tuberculosis

The complication with tuberculosis of the central nervous system (CNS) were studied in 16 patients with miliary tuberculosis who were admitted to our hospital during a period of two years from April, 1997 to March, 1999, and were examined by head MRI. Twelve cases (75%) were diagnosed as having tuberculosis of CNS. Six cases had tuberculosis of CNS which was found during the screening of miliary tuberculosis cases, and all had only cerebral tuberculoma. Meningeal irritative symptoms led to the discovery of tuberculosis of CNS in the remaining six cases, in which cerebral tuberculoma was complicated with tuberculous meningitis. Of these cases of meningitis, three cases showing disturbance of consciousness died, but no cases of death was found in cases by the screening. The length of time from the onset of symptoms to the diagnosis of tuberculosis was long in many of the cases complicated with tuberculosis of CNS compared with the cases without such a complication. In the cases of miliary tuberculosis, the rate of complication with tuberculosis of CNS is high, and the possibility of patients developing serious symptoms suddenly even when they were asymptomatic at the time of diagnosis and the paradoxical expansion that becomes intensified after initiation of treatment have been reported. Therefore, it is necessary to make a close checkup of CNS when the diagnosis of miliary tuberculosis has been made.     

Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis

Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-level obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the operation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient recovered well. An abdominal tuberculoma is often mistaken for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge.     

胸膜结核瘤83例临床和病理及影像学对照研究

目的 探讨胸膜结核瘤的临床、病理和影像学特征.方法 回顾性分析上海市肺科医院2005年6月至2008年6月经病理和(或)细菌学证实的83例胸膜结核瘤患者的临床、实验室检查、病理和影像学等资料.结果 83例中男50例、女33例,年龄7～85岁,平均37.8岁.患者以咳嗽、发热和胸痛为常见症状,无症状者(25例)也不少见;部分患者有阳性体征,如叩诊浊音和呼吸音减低等.83例中合并肺结核36例,80例有明确的结核性胸膜炎病史,3例无明确病史;胸膜炎治疗不及时者45例,抗结核治疗方案不规范者42例,未应用糖皮质激素者48例;59例行CT引导下经皮穿刺活检,24例行胸腔镜手术治疗,其中经病理证实为结核性病变者62例.病理所见:肉芽肿性炎症、凝固性坏死或干酪样坏死、淋巴细胞、类上皮细胞、朗汉斯巨细胞、炎症细胞、脓细胞、组织细胞和瘢痕组织等;15例穿刺物抗酸杆菌染色阳性,21例穿刺物MTB培养阳性.X线胸片示:病变呈单发者68例,多发者15例,以右下肺居多(46例),类圆形影最常见(63例).胸部CT示:病灶密度均匀20例,不均匀40例,伴钙化9例,病灶中心密度较低6例.胸部CT强化扫描示:病灶密度均匀18例,不均匀65例,伴钙化9例,病灶中心密度较低34例,边缘强化者28例.结论 胸膜结核瘤是结核性胸膜炎发生、发展与转归的一个重要过程,掌握其临床、病理和影像学特征,对诊断和鉴别诊断具有重要的价值.     

Tuberculous abscesses in patients with AIDS.

Five cases of large tuberculous abscesses in patients with AIDS were observed over a 2-year period at the New York Veterans Affairs Medical Center. These cases represent 11.6% of the 43 cases of tuberculosis diagnosed in patients with AIDS during that period. The abscesses were located in the liver, abdominal wall, psoas muscle, mediastinum, and peripancreatic area. All patients presented with localized pain or swelling, and four of five patients had fever. The diagnosis was made on the basis of detection of abscesses on computed tomography (CT) and the results of culture of abscess material obtained by CT-guided aspiration. CT-guided therapeutic drainage was performed in two cases. Despite administration of therapy, two of five patients died of tuberculous infection. Formation of tuberculous abscesses appears to be a common complication of tuberculosis in patients with AIDS. This diagnosis should be considered for patients with AIDS who have fever and localized pain or swelling.     

Tuberculous sacro-iliitis: a series of twenty-two cases

BACKGROUND: Despite their relative rarity, increased awareness of tuberculous sacro-iliitis is necessary. Indeed, diagnosis is usually delayed, because of the non specific clinical features and the difficulty to explore the sacro-iliac joint. OBJECTIVE: To study the characteristics of sacro-iliac joint tuberculosis. MATERIALS AND METHODS: A retrospective study of 22 cases of tuberculous sacro-iliitis collected between 1987 and 2003 in four university hospital centres. All our patients were explored clinically and radiologically. Microbiology, biochemical and serologic tests were also performed. RESULTS: 13 cases were confirmed bacteriologically or histologically and for the remaining nine cases evidence of tuberculous sacroiliitis was based on clinical, biological, radiological features and outcome on treatment. Inflammatory pain was present in almost all cases, and a collected abscess in 11 cases. Standard radiographs were also in all cases and ultrasound and CT scan showed an abscess in 8 patients. The average duration of treatment was nine months. The outcome was excellent in the majority of cases. CONCLUSION: Sacro-iliac joint is difficult to explore and has recently beneficiated of technical improvement in imaging and diagnostic. Medical treatment of tuberculosis sacro-iliitis is often sufficient.     

Tuberculoma of the liver

During the period 1973-76 2 patients, neither immigrants, were operated on and found to have tuberculoma of the liver. Both were successfully treated. Tuberculoma of the liver is an uncommon condition and is rarely encountered as a surgical problem. It can, however, present a surgical challenge as it must be distinguished from the more common types of right upper quandrant abdominal lesions such as biliary, gastroduodenal and other hepatic diseases. The occurrence of a tuberculoma of the liver without coexistent tuberculosis elsewhere in the body is extremely rare. Its presence in association with other tuberculous foci, whilst uncommon, has been recorded on a number of occasions.     

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.     

面颈部结核性肿块高频彩超诊断与鉴别诊断价值探讨

目的研究面颈部结核性肿块高频彩超声像图与临床特征,探讨高频彩超诊断价值.方法对23例病理证实的面颈部结核性肿块住院患者的高频彩超与临床特征进行专项回顾性分析,合并与易混淆肿块进行比较.结果 (1)面颈部结核性肿块多发生于青壮年女性,PPD( )100%,合并器官结核占43.5%,合并结核中毒症状占39.1%,病理示干酪性坏死占47.8%.本组23例中淋巴结核17例,皮肤结核3例,颌下腺结核3例;(2)面颈部结核性肿块高频彩超声像图特征为:肿块呈不均质或混合性回声,部分内可见点状强回声或强光团伴声影或不规则无或极低回声干酪性坏死小暗区;彩色多普勒能量图(CDPI):肿块血流显示率13%.结论面颈部结核性肿块高频彩超声像图有一定特征,结合临床高频彩超对其有一定的诊断与鉴别诊断价值.     

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.     

Differential organization of the local immune response in patients with active cavitary tuberculosis or with nonprogressive tuberculoma

BACKGROUND: In 90% of all cases, Mycobacterium tuberculosis infection results in latency rather than active disease, with the pathogen being contained within granulomatous lesions at the site of primary infection. Failure of this containment leads to reactivation of postprimary tuberculosis (TB). The regional immune processes that sustain the delicate balance with persistent M. tuberculosis, however, remain unclear. METHODS: We compared activation statuses, biological functions, and interactions of host immune cells in human nonprogressive tuberculoma and active cavitary tuberculous lung tissue. RESULTS: Dissection of early granuloma formations revealed differential cellular distribution and activation statuses of distinct cell types in different regions relative to the central caseotic caverna or the tuberculoma in tuberculous lung tissue. In patients with tuberculoma with latent infection, distant parts of lung tissue exhibited strong vascularization and profound proliferative activity, indicating that continuous immune defense is required for mycobacterial containment, which is absent in cavitary tuberculous lung lesions. CONCLUSIONS: We conclude that differential regulation of the local immune response is crucial for the containment of M. tuberculosis and that a continuous antigen-specific cross talk between the host immune system and M. tuberculosis is ensured during latency. This activation requires sufficient supply of nutrients and well-coordinated structural organization, both of which are lost during reactivation of TB.     

以磨玻璃样密度影为表现的早期肺癌并发肺结核患者的诊治分析

目的 分析以磨玻璃样密度影(ground-glass opacity,GGO)为表现的早期肺癌并发肺结核患者的临床特点,以达到早期识别及治疗的目的。方法 对山东大学附属山东省胸科医院自2013年1月至2018年2月确诊的14例以GGO为首要表现的肺癌并发肺结核患者的临床表现、CT扫描征象、手术方式、病理类型等进行回顾性分析。结果 以GGO为表现的早期肺癌并发肺结核以查体时发现多见(9/14),CT表现为陈旧性结核病灶并发混合密度GGO(mGGO) 12例;GGO与结核病灶位于同侧同叶4例。术前对患者进行规范抗结核药物治疗9例,术后继续行规范抗结核药物治疗6例。术前有3例患者行CT引导下肺穿刺活检确诊肺癌,其余11例为术中冰冻切片病理检查证实。行肺叶切除加纵隔淋巴结清扫10例,肺叶(GGO病灶所在处)切除加同侧异叶肺结核瘤局部切除2例,肺段切除1例,楔形切除1例。肺结核病灶标本经病理检查确诊10例,另4例依据病史及影像学表现符合陈旧性肺结核诊断;表现为GGO的早期肺癌病灶标本经病理检查确诊腺癌11例,鳞癌1例,腺鳞癌1例,大细胞癌1例。纵隔淋巴结病理检查均未见转移。本组患者术后均顺利康复,短期随访未见肿瘤复发、转移及结核复燃等。结论 GGO为表现的早期肺癌并发肺结核患者其临床表现无特异性,薄层CT扫描加动态观察有利于诊断。手术方式需在肺癌切除的基础上兼顾结核病灶的处理,规范的抗结核药物治疗加手术切除治疗效果满意。