Disseminated Tuberculosis in an Immunocompetent Patient: The Answer is in the Liver

Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affect the lungs. We report a case of disseminated tuberculosis with hepatic, pericardial and pleural involvement and a review of the relevant literature. A 64-year-old Portuguese male was admitted with epigastric and right upper quadrant pain associated with low grade fever, fatigue, nausea, anorexia, weight loss (6 kg) and mild jaundice. A chest X-ray showed cardiomegaly and a computed tomographic scan of the thorax and abdomen revealed a mild left pleural effusion, a thickened pericardium with signs of incipient calcification and hepatomegaly. The echocardiogram suggested the diagnosis of constrictive pericarditis. Liver biopsy revealed granulomatous lesions with central caseating necrosis. Tuberculosis is usually associated with atypical clinical manifestations. Imaging examination combined with histopathological features, a high index of clinical suspicion and improvement with antibacilar therapeutic are necessary to confirm a diagnosis, especially in the cases of extrapulmonary tuberculosis.