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).