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Rare disease
Case report
Looking beyond appearances: when liver biopsy is the key for hepatic tuberculosis diagnosis
  1. Marta Freitas1,2,3,
  2. Joana Magalhães1,2,3,
  3. Carla Marinho1,2,3 and
  4. José Cotter1,2,3
  1. 1Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Braga, Portugal
  2. 2Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
  3. 3ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
  1. Correspondence to Dr Marta Freitas; martaspfreitas{at}gmail.com

Abstract

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.

  • liver disease
  • alcoholic liver disease
  • nonalcoholic steatosis

https://doi.org/10.1136/bcr-2020-234491

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    Footnotes

    • Contributors All authors have contributed to and agreed on the content of the manuscript. MF did the literature research and drafted the manuscript. JM was involved in the patient’s management and revised the manuscript. CM revised the manuscript. JC critically revised the manuscript and approved the final version to be submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.