Korean J Gastroenterol.  2025 Jan;85(1):78-82. 10.4166/kjg.2024.119.

Miliary Tuberculosis Initially Presenting as an Isolated Hepatic Abscess

• Ha CW
• Shin SD
• Goh MJ
• Song BG
• Kang W
• Sinn DH
• Gwak GY
• Paik YH
• Choi MS
• Lee JH

• KMID: 2565018
• DOI: http://doi.org/10.4166/kjg.2024.119

Abstract

Hepatic tuberculosis, typically associated with miliary tuberculosis, can occasionally present as localized liver lesions. This case report describes a 77-year-old male presenting with persistent abdominal pain and fever, following an endoscopic retrograde cholangiopancreatography for bile duct sludge removal. Subsequent computed tomography revealed focal liver lesions. Despite initial treatment with antibiotics for a suspected inflammatory liver abscess, his condition did not improve. A liver biopsy was performed, revealing caseous granulomas, and the tuberculosis polymerase chain reaction result was positive. The patient was diagnosed with primary hepatic tuberculosis, which later disseminated. Oral anti-tuberculosis therapy was initiated and is currently being closely monitored. This case emphasizes the importance of considering hepatic tuberculosis in the differential diagnosis of liver lesions, particularly in cases involving cholestatic liver function tests, and persistent symptoms unresponsive to conventional antibiotics.

Keyword

Hepatic tuberculosis; Hepatic tuberculosis; Liver abscess; Liver abscess

Figure

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  Fig. 1 Axial contrast-enhanced computed tomography: (A) In the arterial phase, a heterogeneous hypodense hepatic nodule 2.5 cm in size is observed in S3/4 of the liver (red arrowhead). (B) In the portal phase, an ill-defined hypodense hepatic nodule is seen. (C) In the arterial phase, a heterogeneous hypodense hepatic nodule 1 cm in size is seen in S8 of the liver (blue arrowhead). (D) In the portal phase, an ill-defined hypodense hepatic nodule is seen (blue arrowhead).

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  Fig. 2 Axial magnetic resonance imaging shows the corresponding lesion. (A) On T1-weighted imaging, a slightly hypodense mass is observed in S3/4 of the liver (red arrowhead). (B) Mild peripheral enhancement is seen in the arterial phase after contrast administration. (C) In the arterioportal phase, the lesion margins remain mildly enhanced, with no enhancement in the central portion. (D) In the portal venous phase, contrast enhancement is more prominent toward the center of the lesion from the peripheral rim. (E) On diffusion-weighted imaging, the suspected area of hepatic tuberculosis shows a high signal. (F) On T2-weighted imaging, the lesion demonstrates a mixed pattern of hyperintense and hypointense signals.

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  Fig. 3 A liver biopsy revealed (A) Chronic granulomatous inflammation and (B) areas of tissue necrosis are observed (Hematoxylin and Eosin stain).

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  Fig. 4 Numerous newly noted micro-nodules are present in both lungs, indicating miliary tuberculosis.

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