Hepatic abscess as a paradoxical response to antituberculous chemotherapy for tubercular lymphadenitis

Abstract

Tubercular liver abscess developing as a paradoxical reaction (PR) to antitubercular therapy (ATT) is relatively uncommon in the absence of disseminated disease and immunocompromised status of the host even in countries such as India where the disease is rampant. We report a rare case of hepatic abscess that developed paradoxically during antituberculous therapy for tubercular lymphadenitis in a 30-year-old woman who tested negative for HIV. Diagnosis was performed with the help of ultrasonography (USG)-guided aspiration of the abscess followed by cytopathological examination and PCR confirmation of the disease from the USG-guided aspirate. The patient responded well to oral corticosteroid therapy without any alteration of the ongoing ATT regimen. Details of the case and other relevant literature regarding the pathogenesis of this event are discussed in detail.

Figure 1

Ultrasonography of the liver showing abscess in the right lobe of the liver in the form of a thick walled area with low level echoes and organised areas measuring 63×60×67 mm.

Figure 2

Cytopathological examination revealing multinucleated giant cells and a large number of lymphocytes on a background of ongoing caseating necrosis.

Figure 3

Ultrasonography after 1 month revealed a normal echotexture of the liver and bile ducts.