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|Year : 1982 | Volume
| Issue : 4 | Page : 221-2
Tuberculous liver abscess. (A case report).
Purohit VP, Verma RR
|How to cite this article:|
Purohit V P, Verma R R. Tuberculous liver abscess. (A case report). J Postgrad Med 1982;28:221
Involvement of liver in miliary tuberculosis is quite common, whereas tuberculous abscess of the liver is a rare condition and till 1977, only 90 cases were reported in the World literature. Since then, some more cases have been added by various workers.,  The rarity of this involvement and paucity of reports in Indian literature prompted us to present this case, emphasizing the diagnostic problem.
G.R., a 63 year old male, was admitted in the Medical Ward of the P.B.M. Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health. At the time of admission, the patient was looking very ill and anaemic, and had a moderate rise of temperature with a pulse rate of 120 per minute and blood pressure of 102/58 mm of Hg. There was no jaundice, no clubbing of forgers, no lymphadenopathy and oedema of the feet.
On clinical examination of the abdomen the liver was palpable about 4 cm below the right costal margin; the margin was sharp, the surface was smooth and soft with tenderness. The intercostal spaces overlying the liver were markedly tender and the upper level of liver dullness was in the right 5th intercostal space in mid-clavicular line. The spleen was not palpable. There was no ascites and any other palpable mass in the abdomen. Respiratory and cardiovascular system examination revealed no abnormality.
Fluoroscopy revealed that right dome of the diaphragm was raised with restriction of movements and there were infiltrations in the right upper zone, suggesting right apical tuberculosis. Haemoglobin was 7 gm%, total leucocyte count was 12,800/cu mm with 69 per cent neutrophils, 20 per cent lymphocytes and 2 per cent monocytes. FSR was 68 mm 1st hour (Westergren Method). The Montoux test was negative; urine was normal and the stool contained cysts of E. histolytica. The sputum for AFB was negative. Liver function tests were normal.
A provisional diagnosis of amoebic liver abscess with pulmonary tuberculosis was made and injection 'Emetine' was started. On the next day, aspiration of the liver abscess was done and about 500 ml of thick cream coloured pus was aspirated. This raised our suspicion towards tubercular liver abscess and it was subjected to laboratory investigations. It was positive for AFB both on smear examination and culture. Simultaneously, the liver biopsy was also taken, which showed typical granulomatous tubercular lesion with caseation. Emetine was immediately stopped and antitubercular treatment consisting of a combination of streptomycin 0.75 g, isoniazide 300 mg and ethambutol 1000 mg per day was started. Along with the above treatment, repeated aspirations were also done and a total of 2400 ml of pus was aspirated. The patient responded well to this therapy, fever subsided, appetite improved end gradually his general condition became better. Later aspirated pus was negative for AFB.
The clinical diagnosis of tuberculous liver abscess had always been difficult. Usual symptoms and signs in this condition, in order of their frequency are fever, chills and soft cystic enlarged liver. Jaundice is seldom encountered. Bacteriological confirmation by smear and culture in suspected cases has also been very rare., Histological diagnosis of the liver abscess has been considered valuable to establish the nature of the disease . The present case was initially simulating amoebic liver abscess and it was only after aspiration, that, tuberculous abscess was suspected and diagnosis was made possible only by smear examination of the aspirated pus and confirmed by culturing Mycobacterium tuberculosis. It was further supported by the histopathological examination of the liver tissue. The prognosis in such cases is goods
We are thankful to the Principal and Controller, S.P. Medical College and Associated Group of Hospitals, Bikaner, for permitting us to publish this case report.
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