A rare case of miliary tuberculosis accompanying perihepatitis

Abstract

Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.

Keywords: Mycobacterium tuberculosis; Tuberculosis, military; Perihepatitis.

Fig. 1.

Chest radiographic findings. (A) Chest posteroanterior view shows widely spread, small, patchy, and nodular opacities throughout both lung parenchyma. (B,C) Computed tomography images of the chest show cavitary nodules (arrows), centrilobular nodules, branching structures, and consolidation in both lung parenchyma.

Fig. 2.

Computed tomography of the abdomen. (A,B) Axial views reveal a thickened linear capsular enhancement of the liver on an arterial-phase image, enlarged paraaortic lymph nodes with internal necrosis, and small bowel mesentery (black arrows). (C) A coronal view shows a moderate amount of ascites in the pelvic and peritoneal cavities (white arrows).