Hepatic Tuberculosis of Pseudotumor Form - Hepatic Tuberculosis of Pseudotumor Form - Open Access Pub

Tuberculosis involving the liver in the absence of active pulmonary tuberculosis is very rare. The inflammatory pseudotumoral form is an entity difficult to diagnose. We report a case of an inflammatory pseudotumor of the liver due to tuberculosis, who didn’t underwent hepatectomy because of the size of the tumor. The diagnosis of tuberculosis was made on biopsy and Polymerase Chain Reaction (PCR). DOI10.14302/issn.2578-2371.jslr-18-1994 Tuberculosis of the liver, especially thepseudotumorform without active pulmonary tuberculosis, is very uncommon. Most of the cases reported in the literature are in the form of localized mass and are usually misdiagnosed as a primary or secondary liver tumor. Final diagnosis is made after multidisciplinary concertation regarding imaging techniques: ultrasonography (US), computed tomography, magnetic resonance imaging (MRI) associated with pathological examination of percutaneous fine-needle biopsy or resected specimen. We report a case of inflammatory hepatic pseudotumor due to tuberculosis diagnosed by polymerase chain reaction. A 50-year-old man, was referred to our center for abdominal pain that had persisted for 1 month with marked loss of weight. An abdominal ultrasound completed by CT scan revealed a tumor of 15 centimeters of main axis of the right liver associated in contact with the portal vein associated with bilateral pulmonary nodules (Figure 1, Figure 2). Family and personal history for tuberculosis were negative. On admission, there was no fever, the abdomen was soft and non-tender, and there was a painful hepatomegaly without palpable mass. Blood showed anicteric cholestasis. Hydatid serology as well as tuberculin skin tests were negative. Upper and lower digestive endoscopy as well as tumor markers were normal. An ultrasound-guided fine-needle biopsy showednecro-inflammatory changes of the liver parenchyma without any signs of malignancy or specificity. Concerning the pulmonary lesions, there were no proof of active tuberculosis (sputum examination and bronchoalveolar lavage showed no BK). Patient received empiric antibiotherapy (amoxicillin and clavulanic acid) with regression of the pulmonary lesions in the control X Ray. Figure 1. Coronal CT scan showing the hypodense heterogeneous liver mass in contact with the portal vein and diaphragm Figure 2. Coronal CT scan showing multiple bilateral pulmonary masses of both lungs associated with centrilobularmicronodules After a multidisciplinary concertation, the hepatectomy was recused because of the size of lesion, the uncertain nature of the lesion and the