Hepatic granuloma. Report of a case successfully treated by hepatectomy and antituberculous therapy

A 62 year-old male presented with high fever, weight loss and painful hepatomegaly. The clinical presentation, results of laboratory studies, angiography and laparotomy suggested hepatic abscess or cholangiocarcinoma. He underwent left lobe hepatectomy, and pathological examinations revealed granuloma. Acid-fast bacilli, fungi and parasites were not identified by special stainings. Hepatic tuberculosis was considered most likely because, after operation, an intermediate-strength purified protein derivative (PPD) skin test gave strongly positive results and his subsequent response to antituberculous treatment was excellent. His complex clinical features and the diagnostic difficulties were outlined.