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Hepatic tuberculosis (TB) is a rare type of extrapulmonary TB. Due to the nonspecific clinical symptoms and imaging manifestations, hepatic TB with human immunodeficiency virus (HIV) infection is easy to be misdiagnosed. We report a case of hepatic TB with acquired immune deficiency syndrome (AIDS), which was initially misdiagnosed as general bacterial liver abscess even after the patient received needle biopsy. In subsequent process, pathogenic tests using washing solution of punctured liver tissue sample were proved feasible, convenient, and specific for pathogenic diagnosis in resource-limited areas of China. For liver abscess in patients with HIV, the pathogens are more complex than HIV negative patients. Some uncommon pathogens, such as TB and fungi, should also be taken into consideration. For the hepatic TB without abscess formation, pathogenic test using washing solution of punctured liver tissue sample should be attached importance.

Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Background Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems. Case presentation A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB. Conclusions A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.

Among patients with HIV and with probable/confirmed TB, using the focused assessment with sonography for HIV-associated TB (FASH) protocol led to a 5-fold increase in the clinician's decision to initiate TB treatment on that day. FASH is a supplementary tool that can help clinicians diagnose patients with HIV-associated TB at the point-of-care and reduce delays in their treatment, particularly when access to other diagnostics is limited or unavailable., Background: The focused assessment with sonography for HIV-associated tuberculosis (TB) (FASH) ultrasound protocol has been increasingly used to help clinicians diagnose TB. We sought to quantify the diagnostic utility of FASH for TB among individuals with HIV in Malawi. Methods: Between March 2016 and August 2017, 210 adults with HIV who had 2 or more signs and symptoms that were concerning for TB (fever, cough, night sweats, weight loss) were enrolled from a public HIV clinic in Lilongwe, Malawi. The treating clinicians conducted a history, physical exam, FASH protocol, and additional TB evaluation (laboratory diagnostics and chest radiography) on all participants. The clinician made a final treatment decision based on all available information. At the 6-month follow-up visit, we categorized participants based on clinical outcomes and diagnostic tests as having probable/confirmed TB or unlikely TB; association of FASH with probable/confirmed TB was calculated using Fisher's exact tests. The impact of FASH on empiric TB treatment was determined by asking the clinicians prospectively about whether they would start treatment at 2 time points in the baseline visit: (1) after the initial history and physical exam; and (2) after history, physical exam, and FASH protocol. Results: A total of 181 participants underwent final analysis, of whom 56 were categorized as probable/confirmed TB and 125 were categorized as unlikely TB. The FASH protocol was positive in 71% (40/56) of participants with probable/confirmed TB compared to 24% (30/125) of participants with unlikely TB (odds ratio=7.9, 95% confidence interval=3.9,16.1; P

Patient: Male, 55-year-old Final Diagnosis: Tuberculosis Symptoms: Liver Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Reactivation of latent tuberculosis infection (LTBI) is a recognized complication of immunosuppressive treatment. However, immunosuppressed patients are also at risk of hematogenous disseminated spread from a primary infection with Mycobacterium tuberculosis. This report presents the case of a 55-year-old Japanese man with a 12-year history of multiple sclerosis who was hospitalized with worsening neurological symptoms and was diagnosed with disseminated tuberculosis identified by abnormalities on liver function test results. Case Report: A 55-year-old Japanese man was admitted to our hospital for the treatment of multiple sclerosis with worsening symptoms. He showed mild liver dysfunction at the time of admission. A laparoscopy and biopsy were performed to identify the cause of the liver dysfunction, which was the only positive finding. The liver surface was studded with yellowish-white nodular lesions. Histological examination of a liver biopsy specimen revealed a granuloma without caseous necrosis. The patient was suspected of having tuberculosis. Although the results of an interferon-γ-releasing assay were indeterminate, asymptomatic disseminated tuberculosis was diagnosed from the serum adenosine deaminase levels, a caseating granuloma in the cervical lymph node, detection of acid-fast bacilli DNA in the cervical lymph nodes on polymerase chain reaction, and tuberculin skin test findings. Anti-tuberculosis treatment led to improvement in the liver function test findings. Conclusions: This case has highlighted that tuberculosis may have an atypical presentation in the immunosuppressed patient. In addition to the reactivation of LTBI, hematogenous spread of primary tuberculosis may result in disseminated disease involving multiple organs and requiring emergency treatment.

Tuberculosis of the stomach is quite rare, both as a primary or secondary infection. It has varied presentation ranging from non-specific abdominal pain and constitutional symptoms to hematemesis, gastric outlet obstruction and pyrexia of unknown origin. Here, we report a rare, interesting case of locally advanced gastric tuberculosis, which morphologically mimicked liver abscess initially in a young, immunocompetent patient presenting with fever and abdominal pain. The disease was diagnosed by GeneXpert MTB/RIF assay, and responded well to antituberculosis medication without surgery. Clinicians must bear in mind that, even in the absence of immunodeficiency, as in this case, tuberculosis can involve any site in the gastrointestinal tract and may present with a variety of presentation and infiltrating adjacent organ that might be mistaken as malignancy. This is first case report of gastric tuberculosis, which is locally advanced with adjacent liver infiltration initially thought to be left lobe liver abscess.

Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.

Abdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumours. We report a case of 38 years old male presenting with abdominal pain, loss of appetite and weight initially misdiagnosed as intrahepatic cholangiocarcinoma on magnetic resonance imaging and FNAC of the lesion but later diagnosed as a case of hepatic tuberculosis on post operative histopathology specimen. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms.

Case Presentation A 32-year-old Nigerian woman, who became pregnant after undergoing in vitro fertilization, was admitted with nausea and abdominal pain. She had a history of two miscarriages and infertility because of tubal blockage treated by salpingectomy. One week prior, she presented to an outside hospital with premature rupture of membranes resulting in stillborn delivery of twins. Endometrial cultures from dilatation and curettage grew Escherichia coli, and she was started on a fluoroquinolone for chorioamnionitis.

Rationale: Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging. Patient concerns: A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination. Diagnoses: The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC). Interventions: Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth. Outcomes: Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver. Lessons: Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.

Case series Patients: Male, 76-year-old • Male, 53-year-old Final Diagnosis: Disseminate tuberculosis and liver tuberculoma Symptoms: Fatigue Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unknown ethiology Background: Miliary tuberculosis (MT) is the disseminated form of tuberculosis (TB) and it is a potentially fatal condition. Diagnosis is often delayed because symptoms are typically nonspecific or absent, and misdiagnosis in favor of other diseases is common. We report 2 cases of disseminated TB that were diagnosed during or after surgeries performed for other suspected diseases. Case Report: Imaging findings are not specific and cannot be relied upon to raise suspicion of MT. In the first case, besides other imaging techniques, we also performed a positron emission tomography-computed tomography (PET-CT) on the patient and the resulting, thick, fluorodeoxyglucose (FDG)-avid ring surrounding the liver first led to concern for peritoneal carcinomatosis. TB peritonitis was only identified on laparoscopy and biopsy. In the second case, CT and magnetic resonance imaging (MRI) findings of a solitary liver mass with an irregular enhancing rim and progressive enhancement led to a radiographic diagnosis of likely intrahepatic cholangiocarcinoma, The subsequent finding that the lesion was intensely FDG-avid without other foci of FDG uptake led to the decision to proceed with resection without a prior biopsy. Conclusions: We have presented 2 patients with TB in whom clinical and imaging findings, and in particular, FDG-PET imaging, led to an erroneous clinical diagnosis of malignancy. An awareness that TB remains very much an active clinical problem in North America and that there are other reasons for FDG uptake on PET imaging besides cancer, is necessary in order to avoid unnecessary and potentially deleterious interventions in patients with TB.

A 65-year-old woman underwent FDG PET/CT for presumed hepatosplenic malignancy suggested by an abdominal CT. The images revealed multiple foci of intense FDG activity in both the liver and the spleen. However, a splenic biopsy result revealed no malignant cells, and either tuberculosis or sarcoidosis was proposed. Following an incomplete antituberculosis therapy, a repeat FDG PET/CT showed resolution of the abnormal activity in the liver and the spleen.

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.

Background Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. Materials and methods A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. Results The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladder's TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. Conclusion Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.

For many years, tuberculosis (TB) has been endemic in Pakistan; many rare and unusual presentations have been reported. There is a myriad of non-specific symptoms which always requires a high index of clinical suspicion for TB. World Health Organization data suggest that Pakistan ranks as the fifth highest country burdened with TB and has the fourth highest prevalence of multi-drug resistant TB globally. With an annual incidence of 277 cases per 100,000, the importance of early diagnosis and treatment is self-evident. We present a case where a strong suspicion of isolated hepatosplenic TB in an immunocompetent patient justified a directed approach.

Liver abscesses, either pyogenic or amoebic, with or without the involvement of the pleura, are not infrequently encountered in children. Isolated tubercular liver abscess without active pulmonary, gastrointestinal or other clinical evidence of tuberculosis is, however, rare and more so its rupture into the pleura. We report a case of a 14-year-old girl who presented with a liver abscess rupturing into the pleura causing an empyema. Successful management was achieved by intercostal tube drainage and antitubercular treatment.

Background Congenital tuberculosis is rare and carries a high mortality rate. Our objective was to summarize the current experience of the diagnosis and treatment of patients with congenital tuberculosis. Methods In total, 73 reported cases of congenital tuberculosis published in Chinese and 19 patients with congenital tuberculosis admitted to West China Second University Hospital, Sichuan University, were retrospectively reviewed. Results Sixty-four male and 28 female patients were identified. The majority of the patients were less than 3 weeks old at the time of presentation (range, 0–67 days). With regard to the tuberculosis type, 89 patients had pulmonary tuberculosis, and 20 patients had hepatic tuberculosis. There was active tuberculosis in 71 mothers, no tuberculosis in 12 mothers, and an unknown history of tuberculosis in 9 mothers. Fever, cyanosis, jaundice, shortness of breath, cough, pulmonary moist rales, hepatomegaly, splenomegaly and abdominal distention were the main clinical symptoms at the time of presentation. The abnormal ratios of chest, abdomen and head radiographic images were 97.53, 75 and 81.25%, respectively. The positive rates of acid-fast staining of sputum smears and tuberculosis bacillus DNA were 62.50 and 66.67%, respectively. The misdiagnosis rate was 59.78%. The overall mortality due to congenital tuberculosis was 43.48%. Respiratory failure was the most common cause of death. Sixty-five patients received anti-tuberculosis therapy, and of those, only 16 (15.38%) died. Conclusions The clinical manifestations and radiographic findings of congenital tuberculosis are nonspecific. It is important to thoroughly evaluate the mothers of infants with suspected congenital tuberculosis. Good outcomes can be achieved in infants with the early identification of congenital tuberculosis and early administration of anti-tuberculosis treatment.

Although tuberculosis (TB) remains a worldwide epidemic, isolated hepatic TB is an extremely rare entity and poorly described in the literature. Isolated hepatic TB may pose a diagnostic dilemma due to the non-specific clinical symptoms and imaging features. We present a case of a 54-year-old female with an isolated caseating granulomatous lesion at the caudate lobe of liver involving the pancreatic head.

Primary hepatic tuberculosis is a rare clinical entity with non-specific clinical and imaging features that can mimic other liver diseases, representing a diagnostic challenge. We report a case of a 35-year-old man with metabolic syndrome, type 2 diabetes and high alcohol consumption presenting asymptomatic with abnormal liver tests, hepatosplenomegaly and diffuse hepatic steatosis in ultrasound imaging initially suspected to be alcoholic steatohepatitis but later diagnosed as hepatic tuberculosis in the histological specimen. Anti-tuberculosis therapy was started. This clinical case highlights the diagnostic difficulty of hepatic tuberculosis and the importance of not overlooking liver biopsy and to consider it in the differential diagnosis in patients with obvious hepatic injury factors but with atypical clinical presentation.

Tuberculosis remains a global health issue affecting millions of people worldwide. Pulmonary form of tuberculosis presents 80-90% of cases with prevalence declining worldwide. On the other hand, extrapulmonary tuberculosis remains at the same level. Extrapulmonary tuberculosis cases are rare at our department. In our article we present a patient who underwent a liver resection with an unexpected finding of liver tuberculosis. In this form of tuberculosis it is difficult to establish a definite diagnosis since clinical symptoms and results of imaging tests maybe equivocal orin determinate. The rare occurrence and the fact that the majority of extrapulmonary tuberculosis cases are not transmitted to other patients lead to lower attention of health professionals. The goal of our article is to bring this rare form of tuberculosis to attention. Inclusion of this form of tuberculosis in differential diagnosis may help to establish correct a diagnosis and therapy. Key words: extrapulmonary tuberculosis - liver.

Tuberculous lesions of the liver frequently occur in autopsy material, even though most of them are clinically unapparent. Pathogenetically, hepatic tuberculosis is a manifestation of general military tuberculosis with the infection brought in through the hematogenous route (through the hepatic artery or the portal system) as a result of intestinal or mesenteric lymph node tuberculosis. We report a case of combination of hepatic tuberculosis and diabetes mellitus in a young woman with reference to the clinical course of the disease, its diagnostics and treatment.

We here report the case of a 58-year old patient admitted with respiratory distress, oxygen desaturation 65% while breathing ambient air and fever 38.5°C. Blood count showed pancytopenia. Ionogram objectified slight hepatic cytolysis and chest X-ray showed bilateral miliaria. BK research using sputum was negative as well as Genexpert TB test. Anatomopathological examination of the osteomedullar biopsy revealed epitheliogigantocellular granuloma without caseous necrosis and polymerase chain reaction (PCR) showed mycobacterium tuberculosis in osteomedullary biopsy. Liver biopsy showed epithelioid granuloma without caseous necrosis. The diagnosis of multifocal tuberculosis with pulmonary, hematopoietic and hepatic impairment was retained. Miliary Tuberculosis is a severe form of tuberculosis. Bacilloscopies are often negative and the diagnosis can be retained based on other sampling, including cerebrospinal fluid sampling and osteomedullary biopsy. Different kinds of biopsies enable diagnosis in rare cases. PCR, a technique used in molecular biology, has enabled to shorten the window period from disease onset to diagnosis as well as treatment implementation. Miliary tuberculosis can be life-threatening; therefore, sometimes, treatment must be administered before certain diagnosis.

Resumen La tuberculosis es una de las enfermedades infecciosas más frecuentes de distribución mundial, con una amplia presentación clínica. La afectación hepática de la tuberculosis es poco frecuente, pero más infrecuente aún lo es el tuberculoma hepático. Se presenta el caso de una paciente con tuberculoma hepático solitario que simula metástasis hepática secundaria a tumor neuroendocrino. Abstract Tuberculosis is one of the most common infectious diseases, with worldwide distribution and ample clinical manifestations. Hepatic tuberculosis is rare but hepatic tuberculoma is even rarer. We report an unusual case of a solitary hepatic tuberculoma simulating hepatic metastasis of a neuroendocrine tumor.

BACKGROUND Hepatic tuberculosis (TB) shows non-specific symptoms, and liver imaging may provide diagnostic clues. Here we describe a series of patients with hepatic TB showing characteristic radiological findings. METHODS Single-centre retrospective evaluation of patients with hepatic TB diagnosed over a period of 16 years who underwent ultrasound, computed tomography (CT) and/or magnetic resonance imaging (MRI). Hepatic lesions were classified as miliary, nodular, serohepatic or cholangitis. RESULTS Of 14 patients with hepatic TB, five were co-infected with the human immunodeficiency virus. All patients had additional extrahepatic TB localisations. An interferon-gamma release assay was performed in 11/14 patients, ultrasound and CT were available for all patients and MRI for four. Observed patterns were miliary (n = 6) with multiple nodules < 2 cm; nodular (n = 5), characterised by a variable number of nodules (2-7 cm); and serohepatic (n = 3), with multiple nodular subcapsular lesions with a thin, smooth wall. Shared findings were hypoechoic lesions on ultrasound, hypodense lesions with ring enhancement on CT, while MRI lesions were hypointense on T1- and hyperintense on T2-weighted images. CONCLUSIONS Ultrasound, CT and MRI can independently contribute to detection of hepatic TB. While a miliary pattern or calcifications are characteristic, no pattern is completely pathognomonic and the diagnosis depends on microbiological evidence. Particularly in risk groups, characteristic radiological findings may prompt targeted diagnostic work-up.

Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.

Background Hepatobiliary tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection, especially in younger patients. The non-specific symptoms and signs as well as the lack of definite imaging characteristics often impedes diagnosis. Definite diagnosis of tuberculosiscan be obtained through histopathological examination; conventional anti-tuberculosis drugs and surgery are the most commonly recommended treatments. Case presentation A previously healthy 15-year-old rural adolescent male presented with a 2-month history of weight loss and fatigue. We strongly suspected a Klatskin tumor; therefore, exploratory laparotomy was performed. However, the microscopical findings revealed a granuloma consisting of epithelioid cells, caseous necrosis, and lymphocytic infiltration, indicating caseating granulomatous inflammation and yielding a final diagnosis of hepatic hilar tuberculosis. Conclusion Hepatic hilar tuberculosis is an extremely rare case; few physicians may have actually treated a case. This report therefore aims to improve the overall understanding of lymphatic tuberculosis of the hepatic hilum.

Summary Background A 45-year-old man who complained of continuous fever and multiple hepatic masses was admitted to our hospital. Repeated MRI manifestations were similar while each radiological report suggested contradictory diagnosis pointing to infections or malignances respectively. Pathologic examination of the liver tissue showed no direct evidence of either infections or tumor. We performed next-generation sequencing on the liver tissue and peripheral blood to further investigate the possible etiology. Methods High throughput sequencing was performed on the liver lesion tissues using BGISEQ-100 platform, and data was mapped to the Microbial Genome Databases after filtering low quality data and human reads. Results We identified a total of 299 sequencing reads of Mycobacterium tuberculosis (M. tuberculosis) complex sequences from the liver tissue, including 8, 229 of 4,424,435 of the M. tuberculosis nucleotide sequences, and Mycobacterium africanum, Mycobacterium bovis, and Mycobacterium canettii were also detected due to the 99.9% identical rate among these strains. No specific Mycobacterial tuberculosis nucleotide sequence was detected in the sample of peripheral blood. Patient's symptom quickly recovered after anti-tuberculosis treatment and repeated Ziehl–Neelsen staining of the liver tissue finally identified small numbers of positive bacillus. Conclusions The diagnosis of this patient was difficult to establish before the next-generation sequencing because of contradictive radiological results and negative pathological findings. More sensitive diagnostic methods are urgently needed. This is the first case reporting hepatic tuberculosis confirmed by the next-generation sequencing, and marks the promising potential of the application of the next-generation sequencing in the diagnosis of hepatic lesions with unknown etiology.

Background Hepatobiliary tuberculosis includes miliary, tuberculous hepatitis or localized forms. The localised form is extremely uncommon and can mimic malignancy. Still rarer is its presentation as sclerosing cholangitis. Case presentation A 50 year male presented with acute onset jaundice, significant weight loss and elevated liver enzymes with clinico-radiological suspicion of cholangiocarcinoma. A left hepatectomy was done and dilated bile ducts filled with caseous necrotic material were seen intra-operatively. Histopathology suggested localized hepatobiliary tuberculosis with features of secondary sclerosing cholangitis. Conclusion Localised hepatobiliary tuberculosis can cause diagnostic difficulties and its possibility should be considered especially in endemic areas.

Isolated macro-nodular liver tuberculosis is a very rare condition. It may mimic primitive or secondary tumors of the liver. This could delay or mislead the therapeutic management. An immunocompetent 48-year-old man with a history of non-metastatic seminoma was treated with right orchidectomy followed by 20 Gy radiotherapy. The discovery, 8 months later, of a 2 cm nodule of the hepatic dome evoked a liver metastasis. Percutaneous biopsy was not feasible. Wedge resection was performed whereas medical treatment would have sufficed, as pathologic examination of the resected specimen showed a macro-nodular hepatic tuberculosis. The patient received anti-tuberculosis drugs for 9 months. The diagnosis of isolated macro-nodular liver tuberculosis is frequently misleading, particularly in immunocompetent and paucisymptomatic patients. Thus percutaneous biopsy is mandatory for diagnosis and also prior to any major surgeries.

Tuberculosis (TB) is a common cause of morbidity and mortality worldwide and its eradication in the United States has stalled for the first time in decades. Isolated hepatic TB is an extremely uncommon form of extrapulmonary TB. Here we present a case of a tuberculous liver abscess and suggest that TB should be considered in patients who fail to respond to antibiotics and prompt diagnostic intervention.

Many case reports describe tuberculosis (TB) co-existent with a malignant neoplasm. However, the neoplasm in most of these reports is lung or breast cancer, with only two cases of liver cancer concomitant with TB reported in the literature. Although both TB and cancer are very common diseases, little attention has been given to the pathophysiologic and practical implications of their co-existence.Case report and literature review.A 73-year-old female patient with a history of hypertension and hepatitis C presented with abdominal pain of 2 mos duration. Laboratory findings showed an elevated serum concentration of α-fetoprotein. A computed tomography scan demonstrated a solitary hypodense tumor in the right lobe of the liver (segment VIII). A pre-operative chest radiograph was within normal limits. The patient underwent an uneventful tumor resection. Histologic examination of a surgical specimen of the tumor demonstrated a moderately differentiated hepatocellular carcinoma co-existent with caseating granulomas.Through this case report, the authors discuss the pathogenesis of the rare association of TB and malignant neoplasm of the liver, and present a review of the current literature on the association of TB and cancer. Further research is required to determine whether a TB infection resembles other chronic infections and inflammatory conditions in having a potential to facilitate oncogenesis.

Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.

Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.

Abdominal tuberculosis (TB) is a relatively rare disease in most of Europe and the typical clinical and sonographic findings in this setting have not been studied. We aimed to define sonographic findings that should alert an examiner to the possibility of abdominal TB in a low endemic region.Case records of 17 patients with proven (n = 11) or highly likely (n = 6) abdominal TB detected in the gastrointestinal ultrasound unit at a German tertiary care center in 2003-2013 were analyzed retrospectively. Findings were compared with reported series from high-prevalence regions.While 76% of patients had an immigrant background, only 35% had a condition associated with immunosuppression. Lymphadenopathy was present in all cases of abdominal TB, while it was absent in 28% of patients from a control group with proven abdominal sarcoidosis. Moreover, retroperitoneal lymphadenopathy was significantly more common in TB. Other findings in patients with abdominal TB in descending order of frequency were ascites, altered hepatic texture, splenomegaly, splenic lesions, peritoneal thickening, intestinal wall lesions, hepatic lesions and hepatomegaly. 76% of abdominal TB patients had 2 or more pathological findings.Multiple pathological intra-abdominal findings including lymphadenopathy should alert the examiner to the possibility of abdominal TB.

Introduction: Peterborough has one of the highest rates of tuberculosis in the East of England; ∼40% of TB treated locally is extra-pulmonary. Aim and methods: All adults diagnosed with abdominal tuberculosis (ATB) between January 2008 and September 2011 in Peterborough Hospitals were retrospectively evaluated with regard to their clinical history, investigation, management and outcomes. Results: In total, 17 patients diagnosed with ATB were reviewed. All the patients were from (or descended from) high-risk ethnic groups. Four had co-existing pulmonary TB. Intestinal and peritoneal TB were the most common findings. The most common clinical manifestations included abdominal pain (71%), weight loss (59%), diarrhoea (47%) and pyrexia (41%). Fifteen patients had samples sent for microbiological investigation; 1 (6%) was smear positive and 9 (53%) were culture positive. Two (12%) were isoniazid resistant. No rifampicin resistance was detected. Anti-tuberculous therapy was given for 6–12 months. In total, 16 (94%) patients completed the treatment; 1 patient died prior to regime completion (crude mortality: 6%). There was one reported case of pyrazinamide intolerance and two episodes of isoniazid intolerance. Discussion: ATB is a diagnostic challenge, especially in absence of lung involvement. It mimics other diseases and clinical presentation is usually non-specific, which may lead to diagnostic delay and development of complications. Extreme vigilance should be used when dealing with unexplained abdominal symptoms to ensure timely diagnosis of ATB. Early diagnosis with early anti-tuberculous therapy and surgical treatment are essential to ensure as positive an outcome as possible.

Mycobacterium tuberculosis infection is one of many opportunistic infections in renal transplant recipients, arising either from reactivation of latent infection or de novo infection, occasionally donor derived. M. tuberculosis hepatitis has never been reported in patients who have received alemtuzumab as part of their renal transplant management. We describe 2 patients who underwent deceased-donor renal transplantation following alemtuzumab induction therapy and presented with a febrile syndrome, subsequently diagnosed as tuberculous hepatitis, one with disseminated disease. Both responded well to treatment without significant side effects, resulting in excellent graft function. The importance of chemoprophylaxis should be emphasized to minimize the risk of developing active tuberculosis in patients with latent tuberculosis infection undergoing solid organ transplantation.

The 5' region of the human lysozyme gene from -3500 to +25 was fused to a chloramphenicol acetyltransferase (CAT) reporter gene and three transgenic founder mice were obtained. All three transgenic lines showed the same pattern of CAT enzyme expression in adult mouse tissues that was consistent with the targeting of elicited, activated macrophages in tissues and developing and elicited granulocytes. In normal mice high CAT enzyme activity was found in the spleen, lung, and thymus, tissues rich in phagocytically active cells, but not in many other tissues, such as the gut and muscle, which contain resident macrophages. Cultured resident peritoneal macrophages and cells elicited 18 hr (granulocytes) and 4 days (macrophages) after injection of sterile thioglycollate broth expressed CAT activity. Bacillus Calmette-Guérin infection of transgenic mice resulted in CAT enzyme expression in the liver, which contained macrophage-rich granulomas, whereas the liver of uninfected mice did not have any detectable CAT enzyme activity. Although the Paneth cells of the small intestine in both human and mouse produce lysozyme, the CAT gene, under the control of the human lysozyme promoter, was not expressed in the mouse small intestine. These results indicate that the human lysozyme promoter region may be used to direct expression of genes to activated mouse myeloid cells.

Mycobacterium tuberculosis remains a leading cause of death worldwide, especially among individuals infected with HIV. Whereas phylogenetic analysis has revealed M. tuberculosis spread throughout history and in local outbreaks, much less is understood about its dissemination within the body. Here we report genomic analysis of 2,693 samples collected post mortem from lung and extrapulmonary biopsies of 44 subjects in KwaZulu-Natal, South Africa, who received minimal antitubercular treatment and most of whom were HIV seropositive. We found that purifying selection occurred within individual patients, without the need for patient-to-patient transmission. Despite negative selection, mycobacteria diversified within individuals to form sublineages that co-existed for years. These sublineages, as well as distinct strains from mixed infections, were differentially distributed throughout the lung, suggesting temporary barriers to pathogen migration. As a consequence, samples taken from the upper airway often captured only a fraction of the population diversity, challenging current methods of outbreak tracing and resistance diagnostics. Phylogenetic analysis indicated that dissemination from the lungs to extrapulmonary sites was as frequent as between lung sites, supporting the idea of similar migration routes within and between organs, at least in subjects with HIV. Genomic diversity therefore provides a record of pathogen diversification and repeated dissemination across the body.