Abstract
Hepatic tuberculosis(hepatic TB) has been well described in patients with miliary tuberculosis.The local form of hepatic TB is very uncommon. Diagnostic criteria of hepatic TB are base on laboratory findings, imaging studies, and clinical response to treatment. Many studies have described hepatic TB in native livers, but to our knowledge, no cases of hepatic TB has been reported in liver allografts. 63 years-old man who underwent orthotopic liver transplant for decompensated hepatitis C cirrhosis presented with abdominal pain, fatigue, decrease appetite, nausea, and vomiting. He has been on immunosuppressant and denies any opportunistic infection post-transplant. No significant abdominal laboratory findings. Abdominal imaging revealed 5.4 x 4.7 cm right lobe liver mass with mild enhancement within the lesion. Biopsy of the mass showed focal granulomatous inflammation and fibrovascular granulation tissue. AFB stain and culture were negative for mycobacteria but quantiferon gamma essay returned positive. He was treated with anti-tuberculosis. Follow up abdominal MRI after treatment revealed resolution of the liver mass. Hepatic masses found in post-transplant liver are often represent hepatocellular carcinoma or nodular regenerative hyperplasia. However, in endemic countries or in suggestive clinical presentations hepatic mass should prompt the clinician to consider hepatic TB as one of the differential considerations. Appropriate treatment with anti-tuberculosis results in good clinical response.Figure: Mass in hepatic segment 7 is worrisome for hepatocellular carcinoma.Figure: Previously noted right hepatic lobe mass is no longer present.
Published Version
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