Dual Portal Hypertension in Hepatic Tuberculosis: A Case Report

Area of Science:

• Hepatology
• Infectious Diseases
• Gastroenterology

Background:

• Hepatic tuberculosis is an uncommon condition.
• Portal hypertension secondary to hepatic tuberculosis is exceedingly rare.
• This report details a unique case of combined intrahepatic and extrahepatic portal hypertension caused by tuberculosis.

Purpose of the Study:

• To present a unique clinical scenario of portal hypertension in a patient with hepatic tuberculosis.
• To illustrate a rare combination of sinusoidal and prehepatic portal hypertension.
• To underscore the importance of considering hepatic tuberculosis in atypical presentations.

Main Methods:

• A 64-year-old female patient presented with esophageal variceal bleeding.
• Diagnostic evaluation included liver biopsy, hepatic venous pressure gradient measurement, and polymerase chain reaction (PCR) for tuberculosis.
• The patient received antitubercular therapy (ATT).

Main Results:

• The patient exhibited sinusoidal portal hypertension due to hepatic granulomas and bridging fibrosis.
• A prehepatic component of portal hypertension was identified, caused by tubercular periportal lymphadenopathy compressing the portal vein.
• PCR confirmed tuberculosis in lymph nodes, and ATT resulted in significant clinical and biochemical improvement.

Conclusions:

• This case represents a novel occurrence of hepatic tuberculosis causing both intrahepatic (sinusoidal) and prehepatic portal hypertension.
• Prompt recognition and treatment of this rare complication with ATT are crucial for favorable outcomes.
• The findings emphasize the importance of considering hepatic tuberculosis in patients with unexplained portal hypertension.