Introduction:
Globally, an estimated 10.0 million people fell ill with (TB) in 2019. TB is a communicable disease that is a major health concern around the world, one of the top 10 causes of death globally and the leading cause of death from an infectious agent.1 (TLA) without active pulmonary or military TB is a rare entity.2Patients usually present with non-specific symptoms, which makes it difficult to diagnose. Here we present a case of an isolated TLA in an immunocompetent patient, in which the patient had symptoms of abdominal pain, vomiting, and fever, with no specific findings to suggest TLA on radiological imaging.
Case presentation :
A 62-year-old male patient presented to our hospital, complaining of a fever of 10 days duration.
This patient is a known case of CKD stage 5, on regular follow-ups, was doing relatively fine when he started having fever for 10 days before presenting to our hospital, the fever was mainly at night, documented at about 38 degrees, associated with chills and rigors, and occasional vomiting.
On physical examination, except for right upper quadrant tenderness, he had no other physical exam findings.
Labs showed: hemoglobin 9.0 gm/dl , White blood cells 24000/mm3 (neutrophils 88%), platelets count 322,000, Blood urea nitrogen 39 mmol/L(high) , Creatinine 567 umol/L (this is his baseline kidney function), C- Reactive protein 136 mg/L (high), Total Bilirubin 21 umol/L (normal range up to 22), elevated liver enzymes, Alkaline phosphatase 514 U/L (normal range up to 129).
The patient was investigated for Hepatitis B, Hepatitis C, and HIV and all were negative, Chest X-ray was normal, routine and microscopic examination of stool showed no cyst or ova; amoebic serology was negative.
US Abdomen was done which showed Ill-defined heterogenous structure noted at the right lobe liver, so MRI abdomen was done for the patient, without contrast, which showed Focal hepatic lesion in segment VIII/IVb (4.8 cm in maximal dimension), Enlarged abdominal lymph nodes, including portocaval lymph nodes which are compressing the mid-CBD and causing upstream biliary dilatation (Figure 1).