Mixed pyogenic and tuberculous liver abscess: clinical suspicion is what matters

Tuberculosis (TB) is a rare cause of liver abscess, even in country like India where it is a very common infection. Moreover, tubercular liver abscess (TLA) is the most unusual pattern of hepatic tuberculosis. We report an unusual case of liver abscess in an immune-competent patient presenting only with weight loss. On investigation, initially it appeared pyogenic, but later turn out to be a mixed infection with tuberculosis. He responded well to antibiotic and antitubercular drugs. A mixed pyogenic and TLA is very uncommon. We conclude that, tuberculosis should be suspected in liver abscess, especially in the absence of typical features and failure to respond to antibiotics.