Isolated Pseudotumoral Hepatic Tuberculosis in an Immunocompetent Adolescent: A Case Report
TL;DR
The case of a 14-year-old boy with no known tuberculosis exposure or underlying immunosuppressive condition who presented with fever, night sweats, anorexia, weight loss, and right upper quadrant pain highlights the importance of considering isolated hepatic tuberculosis in an adolescent with an atypical pseudotumoral or abscess-like liver lesion.
Abstract
Isolated hepatic tuberculosis is exceptionally rare, particularly in immunocompetent children and adolescents, and its nonspecific clinical and radiological presentation may mimic infectious or neoplastic liver lesions. We report the case of a 14-year-old boy with no known tuberculosis exposure or underlying immunosuppressive condition who presented with fever, night sweats, anorexia, weight loss, and right upper quadrant pain. Contrast-enhanced computed tomography demonstrated a 6-cm multiloculated pseudotumoral lesion composed of clustered, coalescent hypodense microcollections involving hepatic segments V, VI, and VII, without pulmonary or other extrahepatic involvement. Liver biopsy revealed epithelioid and multinucleated giant-cell granulomas with central caseous necrosis. Molecular testing, acid-fast staining, and mycobacterial culture were not performed. The patient received antituberculous therapy for nine months. Follow-up computed tomography one year later showed complete resolution, leaving only a small retractile parenchymal scar. This case highlights the importance of considering isolated hepatic tuberculosis in an adolescent with an atypical pseudotumoral or abscess-like liver lesion and the central role of image-guided biopsy in avoiding unnecessary surgery.