Massive Primary Hepatic Tuberculoma Mimicking Hepatocellular Carcinoma in an Immunocompetent Host

Matthew J. Brookes, MB ChB; Melanie Field, MB ChB; Dee M. Dawkins, MB ChB; Joan Gearty, MB ChB; Paul Wilson, MB ChB


July 18, 2006

Abstract and Introduction

Tuberculoma of the liver is rare in an immunocompetent individual. We report a 26-year-old man with upper abdominal pain, abnormal liver function, and raised inflammatory markers. Abdominal computed tomography (CT) scan revealed a mixed attenuation lesion measuring 6 x 5 cm occupying most of the left lobe of the liver. Subsequent histology and culture confirmed tuberculous abscess. Following antituberculous therapy, repeat CT scan revealed complete resolution of the initial findings. This case illustrates the diagnostic difficulties of hepatic tuberculosis (TB) and the importance of considering TB in patients with hepatic lesions.

TB is a growing problem worldwide; consequently, it is vital to recognize the more unusual presentations of this disease. Intra-abdominal TB has a high mortality, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB.[1] We present a case of primary hepatic tuberculoma in an immunocompetent host and illustrate how these cases can be managed nonsurgically.

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