Liver tuberculosis in Southern Taiwan: 15-years clinical experience

Liver tuberculosis (TB) is defined as Mycobacterium tuberculosis infections in the liver and is usually secondary from TB of the lung or other organ. The aims of this retrospective study were to review hepatic TB diagnosed and treated in our hospital and analyze the clinical presentations, image studies and therapeutic outcomes. From January 1992 to December 2006, 1251 patients with pathological diagnosis of TB infection were admitted. Among them, ten patients (5 males and 5 females) with the diagnosis of liver TB were enrolled. The mean age of patients with hepatic TB was 52.7 years (20-76 years). The clinical manifestations were abdominal pain (40%), poor appetite (40%), nausea or vomiting (40%), fever (30%), body weight loss (20%). Three patients were found to have hepatic TB infection incidentally without relevant abdominal symptoms. Four patients had isolated hepatic TB and others had extra-hepatic TB infection. Coexistent pulmonary TB was found in 4 patients. Abdominal sonography and computed tomography (CT) in 9 patients revealed solitary liver tumors with or without calcification, or multiple liver tumors. Diagnostic methods included ultrasound-guided liver biopsy (50%), laparotomy and liver biopsy or hepatectomy (50%), positive liver TB-PCR (30%), positive AFB stain (20%). All 9 patients who had received complete antituberculosis therapy were cured of the disease. In conclusion, liver TB is a rare condition but curable disease. The diagnosis of liver TB is difficult due to non-specific symptoms, signs, and variations on image findings. Therefore, determination of histopathology is necessary for definite diagnosis of liver TB supplemented with TB-PCR and AFB stain. Once the diagnosis is confirmed, the disease is usually associated with good prognosis and long-term outcome under complete anti-TB treatment.