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Case Reports
. 2015 Dec 3;23(4):208-213.
doi: 10.1016/j.jpge.2015.10.002. eCollection 2016 Jul-Aug.

Disseminated Tuberculosis in an Immunocompetent Patient: The Answer is in the Liver

Suzane Ribeiro  1 , Daniel Trabulo  1 , Cláudia Cardoso  1 , Ana Oliveira  1 , Isabelle Cremers  1
Affiliations
Case Reports

Disseminated Tuberculosis in an Immunocompetent Patient: The Answer is in the Liver

Suzane Ribeiro et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affect the lungs. We report a case of disseminated tuberculosis with hepatic, pericardial and pleural involvement and a review of the relevant literature. A 64-year-old Portuguese male was admitted with epigastric and right upper quadrant pain associated with low grade fever, fatigue, nausea, anorexia, weight loss (6 kg) and mild jaundice. A chest X-ray showed cardiomegaly and a computed tomographic scan of the thorax and abdomen revealed a mild left pleural effusion, a thickened pericardium with signs of incipient calcification and hepatomegaly. The echocardiogram suggested the diagnosis of constrictive pericarditis. Liver biopsy revealed granulomatous lesions with central caseating necrosis. Tuberculosis is usually associated with atypical clinical manifestations. Imaging examination combined with histopathological features, a high index of clinical suspicion and improvement with antibacilar therapeutic are necessary to confirm a diagnosis, especially in the cases of extrapulmonary tuberculosis.

A tuberculose, uma doença infecciosa causada pelo Mycobacterium tuberculosis, pode invadir todos os órgãos, afectando sobretudo os pulmões. Relatamos um caso de tuberculose hepática com envolvimento pericárdico e pleural e uma revisão da literatura relevante. Um homem de 64 anos, de nacionalidade portuguesa, foi admitido por dor no quadrante superior direito do abdómen e no epigastro associada a febre baixa, astenia, náuseas, anorexia, perda de peso (6 kg) e icterícia. A radiografia de tórax revelou cardiomegalia e a tomografia computadorizada de tórax e abdómen revelou um derrame pleural esquerdo ligeiro, um pericárdio espessado com sinais incipientes de calcificação e hepatomegalia. O ecocardiograma era sugestivo de pericardite constritiva. A biopsia hepática revelou granuloma com necrose caseosa central. A tuberculose geralmente está associada a manifestações clínicas atípicas. A presença de aspectos imagiológicos em conjunto com características histológicas típicas, um elevado índice de suspeita clínica e resposta à terapêutica antibacilar são necessários para confirmar o diagnóstico, especialmente nos casos de tuberculose extrapulmonar.

Keywords: Immunocompetence; Liver; Tuberculosis.

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Figures

Figure 1
Figure 1
Chest radiograph.
Figure 2
Figure 2
CT scan of the thorax showing a thickened pericardium and left pleural effusion.
Figure 3
Figure 3
Echocardiogram.
Figure 4
Figure 4
Liver histopathological examination: mononuclear cell infiltrate and epithelioid granuloma.
See this image and copyright information in PMC

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