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Fulminant hepatic failure caused by tuberculosis

W Hussain1, D Mutimer, R Harrison

  • 1Liver Unit, Queen Elizabeth Hospital, Birmingham.

Gut
|May 1, 1995
PubMed
Summary

Fulminant hepatic failure and renal failure can be rare presentations of miliary tuberculosis (TB). This case highlights TB as a critical differential diagnosis in patients with acute liver and kidney injury, even with a normal chest X-ray.

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Nephrology

Background:

  • Miliary tuberculosis (TB) is a disseminated form of Mycobacterium tuberculosis infection.
  • Fulminant hepatic failure (FHF) is a rare but severe complication of TB.
  • This report details a unique case of FHF and subsequent renal failure attributed to miliary TB.

Observation:

  • A 54-year-old woman presented with acute liver and kidney failure.
  • Initial investigations, including chest X-ray, were unremarkable.
  • A transjugular liver biopsy revealed caseating granulomas and acid-fast bacilli, confirming miliary tuberculosis.

Findings:

  • Despite antituberculous treatment and supportive care, the patient's condition rapidly deteriorated.
  • Postmortem examination confirmed widespread miliary tuberculosis.

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  • Mycobacterium tuberculosis was isolated from cultures, confirming the diagnosis.

    • Implications:

    • This case underscores the importance of considering miliary TB in the differential diagnosis of unexplained fulminant hepatic failure and acute kidney injury.
    • Hyponatremia and hepatomegaly were key clinical features at presentation.
    • This is the first reported instance of antituberculous treatment initiated before a patient's demise in such a context.