Hepatic tuberculosis
A 48-year-old man presented to an outpatient clinic with a 1-month history of upper abdominal distension, dull pain, and anorexia. He had no cough, fever, night sweats, or history of hepatitis. Liver metastases were suspected in both liver magnetic resonance imaging (MRI) (Panel A) and positron emission tomography-computed tomography (PET-CT) (Panel B) examinations. Hepatic nodules exhibited typical circular enhancement on MRI (Panel C, black arrow). Tests for hepatitis and tumor biomarkers, as well as a chest X-ray, were all normal. Liver puncture biopsy guided by color Doppler ultrasound, the pathological findings were granulomatous inflammation (Panel D) and positive acid-fast staining. Liver function tests showed an increase in glutamyl transpeptidase, alkaline phosphatase, and erythrocyte sedimentation rate, and positive interferon-gamma release assays (IGRAs) results. A diagnosis of hepatic tuberculosis was made on the basis of pathological and IGRAs results. Anti-tuberculosis treatment with quadruple regimen (HRZE regimen, isoniazid, rifampicin, pyrazinamide, and ethambutol) was administered and symptoms improved after 1 month of treatment. After 3 months of treatment, the low-density shadow of liver in MRI decreased significantly (Panel E, black arrow). Compared to tuberculin skin test (TST), IGRAs demonstrate higher specificity and were less susceptible to interference from bacillus Calmette-Guerin (BCG) vaccination. Tuberculosis exhibits heightened metabolic activity for glucose, which can elevate standardized uptake value (SUV) values. Therefore, PET-CT has little value in differentiating tuberculosis from tumors.
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