Short Article - Journal of Biomedical Imaging and Bioengineering (2019) Volume 3, Issue 2
Isolated Tuberculous Liver Abscess in a 63-year-old Immunocompetent Male: A Case Report of an Uncommon Presentation of Extra-Pulmonary Tuberculosis
Hepatic tuberculosis is evident in less than 1% of all TB infections due to the low tissue oxygen tension in the liver, which is hostile for mycobacterial growth. Tuberculous liver abscess (TLA), a subset of hepatic TB is usually associated with pulmonary/gastric TB or with an underlying immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even less common. A case of a 63-yr-old immunocompetent male, with no history of prior pulmonary/gastric TB was initially diagnosed with pyogenic liver abscess treated with Metronidazole and Ciprofloxacin. However, persistence of right upper quadrant pain and jaundice despite compliance to therapy was noted hence admission. Antibiotics were resumed and underwent ultrasound guided liver aspiration draining a thick, light brown abscess. Microbiologic cultures of the abscess were negative but AFB smear revealed 1+ which signifies 10-99 AFB seen/100 visual fields in at least 50 fields. Sputum AFB smear was negative and chest radiograph was normal. HRZE 3 tabs daily was initiated with gradual improvement of abdominal pain with resolution of fever. Repeat ultrasound of the hepatobiliary area one month after discharge showed complete resolution of liver abscess.Currently, there has been no local treatment recommendations specific for isolated TLA due to its rarity. Based on the outcome of this case, it appears that the response to drainage and standard pharmacologic treatment is substantial. The excellent clinical outcome of these patients with appropriate therapy necessitates timely diagnosis of this rare clinical entity and will prevent further unnecessary workups.
Author(s): Lucas Emir Sheikh R. Saturinas