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LETTER TO EDITOR
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 480

Isolated hepatic tuberculosis: A disease of multifaceted presentations


Department of Health Sciences, University “Magna Graecia,” Catanzaro, Italy

Date of Submission16-Oct-2021
Date of Acceptance26-Oct-2021
Date of Web Publication14-Dec-2021

Correspondence Address:
Diego Tonesi
Department of Health Sciences, University “Magna Graecia,” Catanzaro 88100
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_215_21

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How to cite this article:
Tonesi D. Isolated hepatic tuberculosis: A disease of multifaceted presentations. Int J Mycobacteriol 2021;10:480

How to cite this URL:
Tonesi D. Isolated hepatic tuberculosis: A disease of multifaceted presentations. Int J Mycobacteriol [serial online] 2021 [cited 2022 Jan 21];10:480. Available from: https://www.ijmyco.org/text.asp?2021/10/4/480/332363



Dear Editor,

We read with great interest the fascinating case reported by Dhali et al. describing a case of Tuberculosis (TB) granulomatous hepatitis, without pulmonary or a disseminated involvement.[1]

The authors properly point out that the patient presented with fluctuating jaundice, a condition not previously described.

Of more interest, Dhali et al. report that both ultrasound and computed tomography showed hepatomegaly of heterogeneous consistency, with no specific imaging features. Finally, only liver biopsy allowed the diagnosis of hepatic TB by showing caseous granulomas with Langhans giant cells.

The authors rightly highlight that fluctuating jaundice is a rare and not previously documented presentation of primary hepatic TB and may lead to diagnostic dilemmas.

We would like to add that this case further confirms the major diagnostic challenge of isolated hepatic TB, owing to its polymorphic presentation.

More frequently, this condition may present as an isolated focal hepatic lesion that lacking specific imaging features may be mistaken for other focal hepatic lesions, particularly primary liver cancers, as previously reported.[2],[3],[4],[5]

Given that, when diagnosed correctly, it can have a positive outcome, and in view of the absence of specific imaging features, it is mandatory to take this diagnosis into account in patients with icteric hepatitis of unknown cause as well as in the differential diagnosis of isolated focal liver lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dhali A, Dhali GK, Ghosh R, Sarkar A. Primary tubercular granulomatous hepatitis presenting as fluctuating jaundice. Int J Mycobacteriol 2021;10:320-3.  Back to cited text no. 1
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2.
Yang C, Liu X, Ling W, Song B, Liu F. Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma: A case report. Medicine (Baltimore) 2020;99:e22580.  Back to cited text no. 2
    
3.
Forgione A, Tovoli F, Ravaioli M, Renzulli M, Vasuri F, Piscaglia F, et al. Contrast-enhanced ultrasound LI-RADS LR-5 in hepatic tuberculosis: Case report and literature review of imaging features. Gastroenterol Insights 2021;12:1-9.  Back to cited text no. 3
    
4.
Prabhudesai R, Lawande D, Gondal G, Keny S. Primary hepatic tuberculosis masquerading as intrahepatic cholangiocarcinoma. Indian J Tuberc 2019;66:310-3.  Back to cited text no. 4
    
5.
Kobayashi T, Ford B, Sekar P. Mycobacterium avium-intracellulare (MAI) liver abscess mimicking liver metastasis in a patient with rheumatoid arthritis on adalimumab and methotrexate. BMJ Case Rep 2019;12:e230912.  Back to cited text no. 5
    




 

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