A Rare Extrapulmonary Tuberculosis, Hepatic Tuberculosis: A Case Report

Ghea Arifah Shabrina¹, Telly Kamelia²

1Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

2Pulmonary and Respiratory Medicine Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

 

 

 

ABSTRACT

Introduction:

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, a disease that attacks the lung parenchyma and can infect other organs. Tuberculosis is a significant health problem and is highly prevalent in developing countries. Abdominal Tuberculosis (TB) is a rare variant of TB, and hepatic tuberculosis is the most infrequent manifestation of tuberculosis infections.

 

Case Illustration:

A 44-year-old female patient complained of abdominal pain since one year ago. Abdominal pain felt in the lower right abdomen, sometimes spreading to the back side. Abdominal pain felt intermittent, not affected by eating or defecation. There were no complaints of fever, cough, shortness of breath, chest pain, and palpitations. The patient denied weight loss, loss of appetite, night sweats, or fluctuating fever. There was no prior history of tuberculosis. These patients have normal liver function and elevated alkaline phosphatase. Multiple calcified hypodense lesions appear in segments VII-VIII of the liver in a Computed Tomography (CT) Scan. A liver biopsy showed clusters of epithelioid cells accompanied by multinucleated giant cells. There was also necrosis resembling caseous necrosis with negative Acid-Fast Bacteria staining. The histological conclusion was following granulomatous inflammation, the possibility of tuberculosis infection could not be ruled out, and no malignant tumor cells were found in the preparations. The stage of fibrosis is around F2-F3. The patient was then diagnosed with hepatic tuberculosis and received anti-tuberculosis therapy. Obtained resolution of abdominal pain improvement and assessment of liver function remained normal after this 2-week treatment.

 

Conclusion:

Hepatic TB is a manifestation of extrapulmonary TB, which is rarely found. Anamnesis, physical examination, and supporting examinations are carried out to diagnose hepatic TB. Investigations such as imaging and liver biopsy can help diagnose this type of TB. The treatment given for hepatic TB is given according to the same regimen as other extrapulmonary TB.

 

Keywords: Hepatic Tuberculosis, Extrapulmonary Tuberculosis, Diagnosis, Management