Hepatic tuberculomas. A case report.
BACKGROUND
The liver is often involved secondarily by sytemic/extrahepatic vascular, metabolic, infectious, granulomatous, and malignant processes.


METHODS
A 57-year old woman was admitted because of fatigue, malaise, night sweating and right upper abdominal quadrant pain. Physical findings revealed pale skin and mucosae, and hepatomegaly. Laboratory data showed normocytic, normochromic anemia and marked inflammatory syndrome. Real-time ultrasonography revealed one hypo-echogenic nodule, 25 mm in size, in the segment II of the liver, and three hypoechogenic nodules, 11-25 mm in diameter, in segments III and IV. Enlarged lymph nodes, 20-50 mm, were observed in the region of the pancreatic head. Histo-pathological examination of the liver and peritoneum biopsies evidenced granulomas with caseous necrosis and multinuclear Langhans' giant cells, indicating hepatic and peritoneal tuberculosis. The tuberculostatic chemotherapy (isoniazid 300 mg/24h; rifampycin 600 mg/24h and pyrazinamid 2000 mg/24h) was applied for 12 months. The patient responded well to the treatment, followed-up for 6-12 months.


CONCLUSIONS
In the differential diagnosis of focal liver lesions, pseudotumoral hepatic tuberculomas must be considered.
Culafic
Djordje
D
Institute of Digestive Diseases, Mirjevski Venac br. 49, Beograd 11160, Serbia and Montenegro. dculafic@EUnet.yu
Boricic
Ivan
I
Vojinovic-Culafic
Violeta
V
Zdrnja
Milan
M
D000995:Antitubercular Agents / Q000627:therapeutic use*; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D008875:Middle Aged; D009336:Necrosis; D016896:Treatment Outcome; D014375:Tuberculoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D014463:Ultrasonography
D000995:Antitubercular Agents