Hepatic tuberculosis with lower gastrointestinal symptoms mimicking hepatic metastasis: A rare case report

Abstract

Introduction and importance: The co-occurrence of Mycobacterium tuberculosis (MTB) affecting both the lungs and abdominal viscera is quite common, but instances of isolated Hepatic tuberculosis (TB) without concurrent clinical signs of TB are exceedingly rare.

Case presentation: We present a case of a 55-year-old woman who complained of abdominal pain, weight loss, fever and changes in bowel habits. A definitive diagnosis of hepatic TB was made through microscopic examination, revealing necrotizing granulomatous inflammation accompanied by caseous necrosis. The patient received antitubercular therapy without experiencing any noticeable side effects during follow-up.

Clinical discussion: Hepatic TB without active pulmonary TB is quite rare case. The patient presents with abdominal pain, fever, weight loss and jaundice. The diagnostic process includes CT (computerize tomography) imaging and subsequent biopsy to confirm it histopathologically. Following the same approach, we did biopsy from the targeted hepatic lesion that showed hepatic tuberculosis. In most cases it is treated with anti-tubercular drugs. However, some complicated cases might need surgical intervention.

Conclusion: This case report highlights the significance of considering TB into account as a potential cause in patients with lower gastrointestinal symptoms in TB endemic areas by emphasizing the diagnostic challenges posed by hepatic tuberculosis with isolated liver involvement. In order to prevent serious complications of abdominal TB, early diagnosis and timely treatment is crucial.

Keywords: Abdominal symptoms; Biopsy; Diagnostic challenges; Hepatic tuberculosis; Necrotizing granulomatous inflammation.

Fig. 1

CT scan showing thickened rectal wall.

Fig. 2

CT scan showing subcapsular deposits-frosted liver (black arrow) and parenchymal deposits (red arrow) (A). Para-aortic lymphadenopathy (blue arrow) (B). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Colonoscopy images showing normal rectum.

Fig. 4

Endoscopy (normal).

Fig. 5

The examined sections of the liver tissue display distorted architecture, showing numerous granulomas. These granulomas consist of epithelioid cells, which are surrounded by infiltrating lymphocytes and Langhan's multinucleated giant cells. Moreover, areas of tissue necrosis and fibrosis are seen.