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LETTER TO EDITOR
Year : 2022  |  Volume : 11  |  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 Publication14-Jun-2022
Date of Print Publicaton14-Jun-2022

Correspondence Address:
Linda Beenet
Department of Pathology and Laboratory Medicine, University of California Los Angeles Technology Center for Genomics and Bioinformatics, Los Angeles, CA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_232_21

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How to cite this article:
Beenet L. Isolated hepatic tuberculosis: A diagnosis still lacking imaging pattern. Int J Mycobacteriol 2022;11:222

How to cite this URL:
Beenet L. Isolated hepatic tuberculosis: A diagnosis still lacking imaging pattern. Int J Mycobacteriol [serial online] 2022 [cited 2022 Jul 6];11:222. Available from: https://www.ijmyco.org/text.asp?2022/11/2/222/347527



Dear Editor,

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.[1]

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.[2],[3],[4],[5]

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.

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.
Kale A, Patil PS, Chhanchure U, Deodhar K, Kulkarni S, Mehta S, et al. Hepatic tuberculosis masquerading as malignancy. Hepatol Int 2021. [doi: 10.1007/s12072-021-10257-9]. Epub ahead of print.  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.
Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021;76:130-43.  Back to cited text no. 4
    
5.
Yu RS, Zhang SZ, Wu JJ, Li RF. Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol 2004;10:1639-42.  Back to cited text no. 5
    




 

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