|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 222
Isolated hepatic tuberculosis: A diagnosis still lacking imaging pattern
Department of Pathology and Laboratory Medicine, University of California Los Angeles Technology Center for Genomics and Bioinformatics, Los Angeles, CA, USA
|Date of Web Publication||14-Jun-2022|
|Date of Print Publicaton||14-Jun-2022|
Department of Pathology and Laboratory Medicine, University of California Los Angeles Technology Center for Genomics and Bioinformatics, Los Angeles, CA
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Beenet L. Isolated hepatic tuberculosis: A diagnosis still lacking imaging pattern. Int J Mycobacteriol 2022;11:222
In the fascinating case reported by Dhali et al., the authors describe a case of tuberculous granulomatous hepatitis (TB) without pulmonary or diffuse involvement, pointing out that the patient presented with fluctuating jaundice, a condition not previously described.
The authors rightly emphasize that fluctuating jaundice is a rare presentation, never previously reported in primary hepatic TB, and thus may lead to diagnostic dilemmas.
Of considerable interest, Dhali et al. also report that imaging lacked diagnostic features as both liver ultrasound and computed tomography showed hepatomegaly without specific imaging features.
Only liver biopsy led to the diagnosis of hepatic TB, showing caseous granulomas with Langhans giant cells.
This case, in our opinion, confirms the tremendous diagnostic challenge of isolated hepatic TB because of its insidious clinical presentation and imaging appearance.
It is well known that hepatic TB can present as an isolated focal liver lesion that lacks specific imaging features, and therefore can be mistaken for focal liver lesions of other etiology, particularly primary and secondary liver cancer, as previously reported.,,,
Unfortunately, certain patients do not infrequently undergo surgical resection on suspicion of liver cancer and, instead, if diagnosed correctly, might have a positive outcome.
Given the absence of specific imaging features and the risk of misdiagnosis, it would be desirable to carry out studies describing the imaging features of hepatic TB to better characterize the imaging pattern of this misleading condition, to avoid unnecessary surgical resection. In particular, the risk of misdiagnosis should be considered in endemic areas and patients at increased risk for TB.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Dhali A, Dhali GK, Ghosh R, Sarkar A. Primary tubercular granulomatous hepatitis presenting as fluctuating jaundice. Int J Mycobacteriol 2021;10:320-3.
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