Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.
Aged ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis ; Female ; Granuloma ; Hepatitis B* ; Hepatitis* ; Humans ; Liver ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Tuberculosis ; Tuberculosis, Hepatic*

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.
Biopsy ; Biopsy, Needle ; Cholangiocarcinoma* ; Diagnosis, Differential ; Hepatectomy ; Humans ; Liver ; Pathology ; Prevalence ; Tuberculosis ; Tuberculosis, Hepatic* ; Cholangiocarcinoma

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome* ; Hepatic Encephalopathy ; Humans ; Hypersensitivity ; Kanamycin ; Levofloxacin ; Male ; Methylprednisolone ; Middle Aged ; Patient Dropouts ; Pyrazinamide ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

Tuberculosis mainly develops in the lung, but may also rarely invade other parts of the abdominal region. Abdominal tuberculosis is associated with pulmonary tuberculosis in approximately 15% of cases, and abdominal tuberculosis primarily develops in the terminal ileum and lymphatic gland. Moreover, hepatic tuberculosis is uncommon and is usually accompanied with active pulmonary or miliary tuberculosis. Hence, the development of primary hepatic tuberculoma as a single liver mass is very unusual. In the present report, we describe the case of a 63-year-old man with a solitary hepatic tuberculoma; the 6.4 cm mass was incidentally detected during abdominal computed tomography in the asymptomatic patient, and the diagnosis was confirmed by liver biopsy through ultrasonography-guided fine-needle aspiration.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Humans ; Ileum ; Liver ; Lung ; Middle Aged ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Hepatic ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.
Brain ; diagnostic imaging ; Fluorodeoxyglucose F18 ; pharmacokinetics ; Heart ; diagnostic imaging ; Hepatomegaly ; chemically induced ; Humans ; Liver ; drug effects ; Lymphoma ; diagnostic imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Tuberculosis, Hepatic ; diagnosis ; Whole Body Imaging

Humans ; Tuberculosis, Hepatic

Humans ; Male ; Middle Aged ; Tuberculoma ; Tuberculosis, Hepatic

Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.
Abdomen ; Adult ; Biopsy, Fine-Needle ; Cholangiocarcinoma ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Granuloma ; Humans ; Liver Neoplasms ; Magnetic Resonance Imaging ; Male ; Positron-Emission Tomography ; Tuberculosis ; Tuberculosis, Hepatic ; Tuberculosis, Miliary

Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.
Abdomen ; Adult ; Biopsy, Fine-Needle ; Cholangiocarcinoma ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Granuloma ; Humans ; Liver Neoplasms ; Magnetic Resonance Imaging ; Male ; Positron-Emission Tomography ; Tuberculosis ; Tuberculosis, Hepatic ; Tuberculosis, Miliary

A 37 year old female presented with epigastric pain and weight loss over a period of 3 months. Her abdominal CT finding showed a 4.5 cm size hepatic mass and 4.3 cm size pancreatic head mass with multiple macronodules in the liver. At the same time, her chest CT revealed a 5 cm size necrotic mass in the left lower lobe of the lung with multiple bilateral pulmonary nodules. We diagnosed these lesions as tuberculosis through multiple biopsies. She was treated with anti-tuberculous medication. After taking the medications, her symptoms were improved. Twelve months later, imaging studies indicated an improvement in the patient's health. Here we report a case report of multi-organ macronodular tuberculosis in lung, liver and pancreas.
Biopsy ; Female ; Head ; Humans ; Liver ; Lung ; Multiple Pulmonary Nodules ; Pancreas ; Thorax ; Tuberculoma ; Tuberculosis ; Tuberculosis, Hepatic ; Weight Loss