Clinical Characteristics of Rare Extrapulmonary Hepatic Tuberculosis
10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.2025.0517
- VernacularTitle:肺外罕见肝结核的临床特征分析
- Author:
Xingyun HU
1
;
Xiaoyan JIN
1
;
Pan YANG
1
;
Jinglan FU
1
Author Information
1. Department of General Practice， Sun Yat-sen Memorial Hospital， Sun Yat-sen University， Guangzhou 510120， China
- Publication Type:Journal Article
- Keywords:
hepatic tuberculosis;
clinical features;
histopathological diagnosis;
early identification;
retrospective analysis
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2025;46(5):872-880
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveHepatic tuberculosis （HTB）， an exceptionally rare and clinically heterogeneous form of extrapulmonary tuberculosis， is frequently misdiagnosed as hepatocellular carcinoma， lymphoma， or pyogenic liver abscess， this diagnostic challenge contributing to persistently high rates of missed and incorrect diagnoses. This study aims to systematically analyze clinical profiles of HTB patients to provide evidence-based guidance for early identification， accurate diagnosis， and timely intervention. MethodsWe conducted a retrospective analysis of all HTB cases confirmed at Sun Yat-sen Memorial Hospital between January 2012 and December 2023. Comprehensive data were collected and evaluated， including demographic characteristics， clinical presentations， laboratory findings， imaging features， and histopathological results. ResultsTen patients （9 males， 1 female； mean age 44.6±15.5 years） were enrolled totally， with prevalent symptom of abdominal pain or distension （8/10）. Among the patients tested， purified protein derivative （PPD） was positive in 2 of 6 cases， serum tuberculosis antibody was positive in 1 of 5， and T-cell spot of tuberculosis （T-SPOT） was positive in 3 of 5. Chest imaging （n=9） revealed active miliary tuberculosis in 1 case and inactive post-tuberculous sequelae in 5 cases， while the remainder showed no abnormalities. Contrast-enhanced CT （n=6） demonstrated hypodense patchy or nodular lesions with absent or mild heterogeneous enhancement. MRI （n=3） showed well-circumscribed oval/round hypointense lesions on T1-weighted imaging （T1WI） and mildly hyperintense ones on T2-weighted imaging （T2WI） and diffusion weighted imaging （DWI）. Percutaneous or surgical liver biopsy was performed in 8/10 cases， revealing chronic granulomatous inflammation in all subjects and acid-fast bacilli in 2 specimens. ConclusionHTB lacks pathognomonic clinical or radiological features， and conventional laboratory tests exhibit low sensitivity. A high index of suspicion is warranted for patients presenting with hepatic nodular lesions accompanied by fever， abdominal pain， or emaciation. Early pathogen detection and histopathological confirmation via liver biopsy are critical to minimize diagnostic delays and ensure prompt initiation of anti-tuberculous therapy.
