Isolated tubercular hepatic abscess with diffuse pattern mimicking hepatocellular carcinoma in HIV positive patient: a case report

  • Mpho Setime Princess Marina Hospital,Gaborone
  • Godfrey M. Rwegerera School of Medicine,University of Botswana
  • Wahhab Chowdhury National Health Laboratory,Gaborone
Keywords: hepatic abscess, tuberculosis, diffuse pattern, HIV/AIDS, acid fast bacilli, Botswana

Abstract

Isolated hepatic tuberculosis presenting as a mass either with or without fever can be confused with hepatocellular carcinoma. Clinical examination and laboratory investigations are not specific. Radiological investigations such as ultrasound and computed tomography cannot confirm the diagnosis; hence it is vital to always make an effort to demonstrate presence of acid fast bacilli in aspirated pus or necrotic material from a liver mass. We present a case of 50 years old male patient with HIV/AIDS who presented with non-specific symptoms without fever, clinically with hepatomegaly mimicking hepatocellular carcinoma with metastasis. Abdominal ultrasound revealed a mass in the left liver lobe, with diffuse involvement in the right liver lobe. Liver mass histology showed granulomatous pattern with epitheloid cell aggregation. Aspirated blood from fine-needle guided biopsy stained on Ziehl Neelsen for acid fast bacilli turned out positive. Clinical examination did not reveal lymphadenopathy, abdominal ultrasound also ruled out para-aortic lymphadenopathy, and chest x-ray was essentially normal. Evaluation of the patient six months after completing quadruple treatment for tuberculosis showed marked clinical improvement.  The objective of this case report is to highlight the importance of considering hepatic tuberculosis as a differential diagnosis in cases of hepatomegaly and initiate appropriate investigations to rule out a possibility of Tuberculosis which is potentially treatable with early diagnosis.

Author Biographies

Mpho Setime, Princess Marina Hospital,Gaborone
Medical officer,Department of Internal Medicine
Godfrey M. Rwegerera, School of Medicine,University of Botswana
Lecturer,Department of Internal Medicine
Wahhab Chowdhury, National Health Laboratory,Gaborone
Pathologist,Department of Histopathology
Published
2014-10-12
How to Cite
SetimeM., RwegereraG. M., & ChowdhuryW. (2014). Isolated tubercular hepatic abscess with diffuse pattern mimicking hepatocellular carcinoma in HIV positive patient: a case report. Tanzania Journal of Health Research, 16(4). https://doi.org/10.4314/thrb.v16i4.11
Section
Articles

Journal Identifiers


eISSN: 1821-9241
print ISSN: 1821-6404