Frequency and predictive factors of granulomatous hepatitis in patients with peritoneal tuberculosis.
OBJECTIVE
The aims of our study were to determine the frequency of granulomatous hepatitis in patients with peritoneal tuberculosis, to identify factors for high risk and whether it is associated with higher frequency of antituberculous treatment side effects.


METHODS
We carried out a prospective study on patients with histologically proven peritoneal tuberculosis between January 1996 and December 2005. We performed a liver biopsy in all the patients before starting the antituberculous treatment. Granulomatous hepatitis was systematically searched in all patients.


RESULTS
The study was conducted in 52 patients, 9 men and 43 women of median age of 35,5 years. A granulomatous hepatitis was seen in 24 patients (46%). In univariate analysis the factors associated with a high risk of liver involvement were a higher level of gamma-glutamyl transpeptidase (44.5 + 36.8 IU/l vs 23.3 + 9.28 IU/l p = 0.005), a higher level of phosphatases alkalines (233.9 + 96.6 IU/l vs 189.4 + 49.9 IU/l p = 0.03) and a lower level of cholesterol (1.22 + 0.2 g/l vs 156 + 0.3 g/l p < 0.0001). In multivariate analysis, only a cholesterol level lower than 1,31 g/l was significantly associated with a granulomatous hepatitis (p = 0.006 OR [IC 95%]: 0.10 [0.02-052]).


CONCLUSIONS
We have found a frequent liver involvement in the case of peritoneal tuberculosis (46%). Cholesterol level lower than 1,31 gr/l was an independent predictor of granulomatous hepatitis in patients with peritoneal tuberculosis. We suggest, in this case, that percutaneous liver biopsy can be considered as an alternative to laparoscopy.
Ben Mustapha
Nadia
N
Department of Gastroenterology A, La Rabta Hospital, Tunis, Tunisia.
Karoui
Sami
S
Serghini
Meriem
M
Kallel
Lamia
L
Mekni
Amina
A
Chebbi
Faouzi
F
Matri
Samira
S
Haouet
Slim
S
Boubaker
Jalel
J
Ben Safta
Zoubeir
Z
Filali
Azza
A
D000328:Adult; D005260:Female; D006099:Granuloma / Q000453:epidemiology / Q000209:etiology*; D006505:Hepatitis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D014395:Peritonitis, Tuberculous / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors