The authors have declared that no competing interests exist.
Tuberculosis involving the liver in the absence of active pulmonary tuberculosis is very rare. The inflammatory pseudotumoral form is an entity difficult to diagnose. We report a case of an inflammatory pseudotumor of the liver due to tuberculosis, who didn’t underwent hepatectomy because of the size of the tumor. The diagnosis of tuberculosis was made on biopsy and Polymerase Chain Reaction (PCR).
Tuberculosis of the liver, especially thepseudotumorform without active pulmonary tuberculosis, is very uncommon. Most of the cases reported in the literature are in the form of localized mass and are usually misdiagnosed as a primary or secondary liver tumor. Final diagnosis is made after multidisciplinary concertation regarding imaging techniques: ultrasonography (US), computed tomography, magnetic resonance imaging (MRI) associated with pathological examination of percutaneous fine-needle biopsy or resected specimen. We report a case of inflammatory hepatic pseudotumor due to tuberculosis diagnosed by polymerase chain reaction.
A 50-year-old man, was referred to our center for abdominal pain that had persisted for 1 month with marked loss of weight. An abdominal ultrasound completed by CT scan revealed a tumor of 15 centimeters of main axis of the right liver associated in contact with the portal vein associated with bilateral pulmonary nodules (
After a multidisciplinary concertation, the hepatectomy was recused because of the size of lesion, the uncertain nature of the lesion and the small remaining liver in case of surgery. The pathological examination was performed again showing inflammatory pseudotumor of the liver (
The patient was treated with tuberculostatic drugs (association of isoniazid, ethambutol and rifampicin) with good clinical tolerance. The use of pyrazinamide was recused because of cholestasis. After a 4-months follow-up period, the patient improved his general condition and laboratory tests (regression of the cholestasis). Control abdominal ultrasound showed regression of the tumor (8cm of main axis) at 3 months of treatment.
Tuberculosis is a monumental health problem and it remains a healthcare challenge in the developed world owing to immigration from endemic areas, increased prevalence of immunosuppression, and emergence of multidrug- and extensively drug-resistant strains of Mycobacterium tuberculosis
Hepatic tuberculosis is usually disseminated associated with miliary tuberculosis in 80% of cases and primary tuberculosis of liver is uncommon
The clinical presentation is not specific and a high degree of clinical suspicion is required to diagnose the entity. There is often abdominal pain with fever associated with a biological inflammatory syndrome
For most authors the diagnosis can be reached based either on the presence of hepatic granulomas associated with documented tuberculosis in another organ, particularly the lungs, or when the clinical symptoms and radiological examination evidence regress after starting up antituberculous treatment
The main stay of treatment is antitubercular drug therapy. Chemotherapy with standard anti-tuberculosis drugs remains the cornerstone of treatment. In general, a 6- to 9-months regimen 2 months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4-7 months of isoniazid and rifampin) is the recommended treatment forextrapulmonary tuberculosis
Cumulative mortality for hepatic tuberculosis ranges between 15% and 42%