title: Liver tuberculosis presenting as an uncommon cause of pyrexia of unknown origin: positron emission tomography/computed tomography identifies the correct site for biopsy.
abstract: OBJECTIVE
  To identify the correct site to biopsy in a case of pyrexia of unknown origin (PUO) caused by hepatic tuberculosis (TB).
  
  
  METHODS
  A 58-year-old man who developed hepatic TB presented with PUO. Ultrasonography (US) and computed tomography (CT) of the abdomen showed only calcifications in the liver, and positron emission tomography (PET)/CT showed diffuse increased metabolic activity in addition to focal areas of increased activity. A diagnosis of hepatic TB was confirmed by histological examination of liver tissues and interferon-γ release assays (IGRAs of T-SPOT/TB). The patient was treated with 4 anti-tubercular therapies (rifampicin, isoniazid, ethambutol and pyrazinamide). At the 3-month follow-up, the patient was disease free as confirmed by abdominal US.
  
  
  CONCLUSIONS
  PET/CT was helpful in identifying a site to biopsy that led to the correct diagnosis.
authors.affiliation: State Key Laboratory of Infectious Diseases and Department of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
authors.forename: Hai-Ying
authors.initials: HY
authors.lastname: Yu
authors.forename: Ji-Fang
authors.initials: JF
authors.lastname: Sheng
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D005334:Fever / Q000209:etiology*; D006801:Humans; D059425:Interferon-gamma Release Tests; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014386:Tuberculosis, Hepatic / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents