Case report on serohepatic tuberculosis (frosted liver): Clinical presentation, imaging, diagnosis, and management

Hepatic tuberculosis can manifest in various forms, including parenchymal, serohepatic, tuberculous cholangitis and mixed form. Isolated hepatic tuberculosis, specifically in the form of serohepatic tuberculosis, is very rare. Patients with hepatic tuberculosis often present with nonspecific symptoms such as abdominal pain, weight loss, night fever, night sweats, hepatomegaly, and abnormal liver function tests. This case involves a young male with isolated serohepatic tuberculosis who presented to the outpatient department of a tertiary care center with complaints of abdominal discomfort, weight loss, and evening rise in temperature. His liver function tests showed elevated levels of alanine transaminase and aspartate aminotransferase. Ultrasonography of the abdomen revealed multiple subcapsular necrotic lesions in the right lobe of the liver. A contrast-enhanced computed tomography scan of the abdomen showed a few hypodense subcapsular lesions in the right lobe and a minimal subcapsular collection. There was mild thickening and enhancement of the liver capsule and sub capsule, creating a frosted liver or sugar-coated appearance. A small subcentimetric size parenchymal lesion was present in segment VIII, which was in continuity with the subcapsular collection. Fine needle aspiration cytology from the largest subcapsular liver lesion revealed acid-fast bacillus, confirming the tuberculosis diagnosis. A high-resolution CT scan of the chest was performed for further evaluation and showed no abnormalities. The patient is currently being treated with antitubercular therapy.