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Primary tubercular granulomatous hepatitis presenting as fluctuating jaundice
Arkadeep Dhali1, Gopal Krishna Dhali2, Ranajoy Ghosh3
1Department of GI Surgery, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India.
International Journal of Mycobacteriology
|September 8, 2021
Summary
Primary hepatic tuberculosis (TB) is rare, and fluctuating jaundice is an undocumented presentation. This case highlights a unique patient with fluctuating jaundice caused by isolated liver TB, emphasizing diagnostic challenges.
Area of Science:
- Hepatology
- Infectious Diseases
- Gastroenterology
Background:
- Granulomatous hepatitis is an uncommon manifestation of tuberculosis (TB).
- Isolated hepatic TB, without pulmonary or disseminated disease, is exceptionally rare.
- Cholestatic jaundice is a typical presentation, but fluctuating jaundice is not documented.
Observation:
- A 46-year-old woman presented with fluctuating, painless jaundice, fatigue, pruritus, and weight loss.
- Initial investigations revealed anemia and a cholestatic jaundice pattern.
- Imaging showed hepatomegaly; MRCP indicated cholecystitis and postinflammatory changes in hepatic ducts.
Findings:
- Liver biopsy confirmed caseating granulomas with Langhans giant cells and abundant acid-fast bacilli.
- Standard TB tests (sputum staining, NAAT) were negative.
- The patient was diagnosed with primary hepatic TB.
Implications:
- This case represents a rare, undocumented presentation of fluctuating jaundice in primary hepatic TB.
- Such presentations can lead to significant diagnostic challenges.
- Prompt diagnosis and initiation of anti-tubercular treatment (ATT) are crucial for patient recovery.
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