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Tuberculosis, or TB, is a bacterial infectious disease caused by Mycobacterium tuberculosis. While its primary impact is on the lungs, leading to pulmonary tuberculosis, it can also affect various other organs, a condition referred to as extrapulmonary tuberculosis.
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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Primary hepatic tuberculosis presenting as acute liver failure.

Deepak Jain1, H K Aggarwal1, Promil Jain2

  • 1Department of Medicine , Pt. B.D. Sharma University of Health Sciences , Rohtak, Haryana , India.

Oxford Medical Case Reports
|May 20, 2015
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Summary

Hepatic tuberculosis, rare without miliary spread, can mimic liver abscesses and tumors. Autopsy confirmed Mycobacterium tuberculosis in a young woman presenting with acute liver failure.

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Pathology

Background:

  • Abdominal tuberculosis is prevalent in the Indian subcontinent.
  • Hepatic tuberculosis, distinct from miliary abdominal tuberculosis, is infrequently documented in English literature, often presenting as case reports or small series.
  • Isolated hepatic tuberculosis can be misdiagnosed, mimicking common liver pathologies such as abscesses and tumors.

Observation:

  • A 25-year-old immunocompetent female presented with symptoms indicative of acute liver failure.
  • Abdominal ultrasonography revealed multiple hypoechoic lesions within the liver.
  • Despite rapid deterioration and expiration within 48 hours of admission, post-mortem liver examination provided crucial diagnostic information.

Findings:

  • Liver autopsy revealed extensive epithelioid cell caseating granulomas, characteristic of tuberculosis.
  • Microscopic examination of liver tissue showed positive staining for acid-fast bacilli (AFB).
  • Molecular analysis via Polymerase Chain Reaction (PCR) confirmed the presence of Mycobacterium tuberculosis DNA.

Implications:

  • This case underscores the importance of considering hepatic tuberculosis in the differential diagnosis of acute liver failure, even in immunocompetent individuals.
  • The findings highlight the diagnostic challenges posed by isolated hepatic tuberculosis, emphasizing the role of autopsy and molecular methods when clinical presentation is atypical.
  • Early recognition and treatment are crucial for improving outcomes in hepatic tuberculosis, necessitating increased awareness among clinicians managing liver diseases.