Korean J Gastroenterol.  2013 Jul;62(1):64-68. 10.4166/kjg.2013.62.1.64.

A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response

• Kim TK
• Choi CW
• Ha JK
• Jang HH
• Park SB
• Kim HW
• Kang DH

• KMID: 1711282
• DOI: http://doi.org/10.4166/kjg.2013.62.1.64

Abstract

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diasnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.

Keyword

Paradoxical response; Tuberculous liver abscess; Tuberculous peritonitis

MeSH Terms

Antitubercular Agents/*adverse effects/*therapeutic use
DNA, Bacterial/analysis
Humans
Laparoscopy
Liver/pathology/ultrasonography
Liver Abscess/*chemically induced/*diagnosis/microbiology
Male
Mycobacterium tuberculosis/genetics/isolation & purification
Necrosis/pathology
Peritoneum/pathology
Peritonitis, Tuberculous/*drug therapy
Tomography, X-Ray Computed
Tuberculosis/*diagnosis/microbiology
Young Adult
Antitubercular Agents
DNA, Bacterial

Figure

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  Fig. 1. (A) Initial pelvic CT before antituberculosis therapy showed a lot of ascites and omental smudge (arrow). (B) Follow-up CT 2 months after starting antituberculosis therapy showed decrease of ascites and omental smudge (arrow).

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  Fig. 2. Gross findings through the laparoscope. Diffuse whitish nodules with ascites were noted on the peritoneum.

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  Fig. 3. Microscopic findings of the peritoneum. Multinucleated giant cell and chronic granulomatous inflammation with caseous necrosis was noted (H&E, ×200).

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  Fig. 4. (A) After treatment for 2 months, a new small low-attenuation nodule was noted on subcapsular area of the S5 segment (arrow). (B) After treatment for 6 months, the size of lesion increased (arrow). (C) After treatment for 13 months, the lesion disappeared (arrow).

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  Fig. 5. Microscopic findings of the liver. The specimen showed chronic granulomatous inflammation with caseous necrosis (H&E, ×100).

Reference

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