Hepatic tuberculosis – a case series

Abstract

Introduction: Non-specific symptoms and lack of characteristic imaging make isolated liver tuberculosis (TB) diagnosis difficult. To examine diagnostic pathways we retrospectively reviewed a series of liver TB cases in East London. Methods: The London TB Register was used to identify cases between 2011 and 2016 across three London boroughs. Only cases specifically identifying the liver as a disease site were selected. Notes and electronic records were searched to collect data. Results: During the study period, 3419 patients were notified; of which 17 were identified as having liver TB (0.50%). Mean age was 44 years (±12.1). 53% were male, 88% were born outside the UK. 47% had at least two classical TB symptoms (night sweats, fevers or weight loss). 18% had initial signs/symptoms suggesting liver involvement. 24% were HIV positive, 12% were hepatitis B positive. Of liver ultrasounds performed, 38% were normal, 23% had a focal lesion, 23% hepatomegaly and 23% parenchymal change. Of CT scans performed, the liver was normal in 35%, 43% had a focal liver lesion, 7% had hepatomegaly and 14% had parenchymal liver change. 47% had extra-hepatic involvement. 71% had a liver biopsy; 89% showed granulomatous inflammation. 83% were not sent for culture. Mean time from symptom onset to treatment start was 5.9 months (±7.9). All patients commenced standard quadruple therapy. Of six culture positive cases, one was isoniazid resistant. Two patients had a mild, transient rise in their LFTs not affecting treatment. Conclusion: Isolated liver TB is rare but curable. Early diagnosis can reduce morbidity. In our cohort, time between symptom onset and diagnosis was unacceptably high – more than twice that of lung TB. Opportunities to send biopsies for culture were often missed.