Tuberculosis on two fronts: A case report of liver and stomach involvement in a patient

Tuberculosis (TB) is a chronic disease caused by Mycobacterium tuberculosis, primarily affecting the lungs but can also affect other organs. In 2021, 10.6 million people became ill with TB, and 1.6 million died. Abdominal TB is rare, accounting for 1-3 % of cases, and often involves the ileocecal region. Stomach and duodenal TB are uncommon and challenging to diagnose as they mimic other conditions. Hepatic TB is rarer, accounting for < 1 % of TB cases, and has non-specific symptoms such as fever, hepatomegaly, and weight loss.

A 26-year-old female healthcare worker experienced fatigue and abdominal pain in the epigastric and right upper quadrant areas, prompting her visit to a gastroenterology clinic. She did not have any other accompanying symptoms, such as nausea, vomiting, weight loss, fever, or night sweats, and upon examination, she exhibited mild epigastric tenderness without any mass. Laboratory tests revealed anemia, mild thrombocytosis, and elevated erythrocyte sedimentation rate. Upper endoscopy uncovered multiple small, clean-based ulcers in the antrum and bulb, and biopsies confirmed chronic granulomatous gastritis in the stomach and duodenum. Abdominopelvic ultrasonography showed heterogeneous liver parenchymal echogenicity and multiple small, ill-defined hyperechoic areas in both liver lobes. At the same time, CT scans of the chest, abdomen, and pelvis exhibited multiple hypodense lesions with peripheral rim enhancement in the liver and clear lungs. The patient was given anti-tuberculosis drugs and responded well. Follow-up after six months revealed no significant findings.

Clinicians in TB-endemic regions should maintain a high index of suspicion for gastrointestinal and liver TB in patients presenting with some abdominal and constitutional symptoms. The most sensitive imaging modality for hepatic TB is a CT scan, while the most specific diagnostic modality is a CT or Sono- guided liver biopsy.