Clinical features of hepatic tuberculosis in biopsy-proven cases

doi:2009.15.2.159

Korean J Hepatol > Volume 15(2); 2009 > Article

The Korean Journal of Hepatology 2009;15(2): 159-167.
doi: https://doi.org/10.3350/kjhep.2009.15.2.159

Clinical features of hepatic tuberculosis in biopsy-proven cases

Sung Wook Hwang, M.D., Yoon Jun Kim, M.D., Eun Ju Cho, M.D., Jong Kyung Choi, M.D., Se Hyung Kim, M.D.1, Jung-Hwan Yoon, M.D., Chung Yong Kim, M.D., Hyo-Suk Lee, M.D.

Department of Internal Medicine and Liver Research Institute, 1Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

ABSTRACT

Background
s/Aims: Hepatic involvement is frequently observed in patients with miliary tuberculosis, but primary hepatic tuberculosis with no clinical extrahepatic manifestations of tuberculosis is uncommon. With the ever-increasing number of immunocompromised patients, it is expected that hepatic tuberculosis will occur more frequently. The aim of the present study was to establish the clinical manifestations and course of the disease. Methods: From January 1989 to September 2008, 12 patients were diagnosed with hepatic tuberculosis by liver biopsy at Seoul National University Hospital. We retrospectively evaluated their clinical, laboratory, and imaging findings by medical record review. Results: Four patients had primary hepatic tuberculosis, and eight patients had hepatic tuberculosis secondary to pulmonary or miliary tuberculosis. Three patients were immunocompromised, and six patients had no previous medical problem. An elevated serum level of alkaline phosphatase was the most frequently observed finding in laboratory tests. Imaging studies showed variable findings, including hepatosplenomegaly, multiple hepatic nodules, abscess formation, and even normal findings. Ten patients responded to antituberculosis drugs, and two cases with tuberculous liver abscess had persistent disease despite prolonged therapy. Conclusions: In patients with a protracted illness, hepatosplenomegaly and/or abnormal liver function tests, hepatic tuberculosis should be suspected, even in healthy young patients or patients with normal imaging findings. Patients with tuberculous abscess formation tend to respond poorly to antituberculosis therapy, and surgery could be considered in these patients. (Korean J Hepatol 2009;15: 159-167)

KeyWords: Hepatic tuberculosis; Primary; Miliary; Abscess