Features and Outcome of Hepatobiliary Tuberculosis among Filipino Children: Report of a Six-year Experience

Abstract

Background. The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reportedin children.
 Objective. To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome ofchildren diagnosed with HBTB.
 Methods. Data of HBTB patients aged 0-18 years were collected by review of medical records and as they wereadmitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/livertissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence).
 Results. A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%)and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolongedprothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most commonimaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%)are alive, nine with complete resolution of liver disease.
 Conclusion. Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Severalinvestigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory withpossible resolution of liver disease.