Tubercular liver abscess: a distinct entity not to be missed

Area of Science:

• Hepatology
• Infectious Diseases
• Radiology

Background:

• Liver abscess is common in developing nations, with amoebic and pyogenic abscesses being most frequent.
• Tubercular liver abscess (TLA) is an important differential diagnosis, with a rising incidence.
• TLA often presents without obvious pulmonary or gastrointestinal infection foci.

Purpose of the Study:

• To investigate the clinical and imaging characteristics of tubercular liver abscess.
• To establish the increasing incidence of TLA.
• To highlight TLA as a critical differential diagnosis in subacute liver abscess cases.

Main Methods:

• A prospective observational study included 72 indoor liver abscess cases.
• Abscess fluid was aspirated for microbiological examination (AFB testing).
• Clinical, laboratory, and ultrasonographic data were collected and analyzed.

Main Results:

• Five cases of TLA (AFB positive) were identified.
• TLA patients were young males (mean age 28.4 years) with subacute presentation.
• Common findings included splenomegaly (60%), ascites (40%), elevated ESR (80%), low hemoglobin (80%), and markedly elevated ALP (all cases).
• Ultrasonography revealed multiple abscesses (<5 cm) often in the seventh segment.
• All TLA cases responded well to anti-tubercular therapy.

Conclusions:

• TLA incidence is increasing, often presenting incidentally.
• High clinical suspicion is crucial for TLA diagnosis in patients with subacute presentation, anemia, splenomegaly, or ascites.
• Elevated ESR, high ALP, and multiple, small ultrasonographic lesions are characteristic of TLA.