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Miliary Tuberculosis of the Liver

Hepatic Miliary Tuberculosis


Presentation

  • An exquisite art program that focuses on clarity of presentation with an emphasis on anatomy, pathology, patient presentation, and clinical context.[books.google.com]
  • Similarly, isolated hepatic tuberculosis presenting as jaundice and abdominal distension has been reported in literature by Shastri et al . [ 9 ] However, hepatic TB presenting as acute liver failure has not been reported in literature.[academic.oup.com]
  • The clinical presentation of ILT is so rare and atypical that it challenges the clinical acumen of the treating physician ( 2 ).[ispub.com]
  • Here we did a case study of disseminated tuberculosis with unusual presentation.[omicsonline.org]
  • , Switzerland Correspondence to Dr Bidisha Chatterjee, bidisha.chatterjee{at}pom.be.ch Summary We present an atypical case of tuberculosis in an immunocompetent man from west Africa living in Europe.[casereports.bmj.com]
Fever
  • She developed incontinence of urine and was brought to our medical centre with fever, episodic unconsciousness and incontinence of urine.[jpma.org.pk]
  • On the other hand, the absence of epidemiologic features and cardiac valvulopathy made the diagnosis of brucellosis and Q fever less likely.[elsevier.pt]
  • Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever[basicmedicalkey.com]
  • Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health.[jpgmonline.com]
  • If bacteria are intermittently released into the bloodstream from an unrecognized infection, people may have a fever that comes and goes and may gradually lose weight, wasting away.[merckmanuals.com]
Fever
  • She developed incontinence of urine and was brought to our medical centre with fever, episodic unconsciousness and incontinence of urine.[jpma.org.pk]
  • On the other hand, the absence of epidemiologic features and cardiac valvulopathy made the diagnosis of brucellosis and Q fever less likely.[elsevier.pt]
  • Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever[basicmedicalkey.com]
  • Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health.[jpgmonline.com]
  • If bacteria are intermittently released into the bloodstream from an unrecognized infection, people may have a fever that comes and goes and may gradually lose weight, wasting away.[merckmanuals.com]
Pain
  • The patient entered the hospital with a painful lump of 3 cm on his right clavicule which he noticed 2 weeks before and back pain. During the examinations for further evaluation his condition deteriorated within short time.[casereports.bmj.com]
  • During the first few days of hospital stay, there was improvement of right upper abdominal pain but afterwards the patient started to complain of a precordial sharp pain worsening with deep inspiration and had evening fever (up to 39.5 C), with chills[elsevier.pt]
  • The most common clinical findings are abdominal pain, fever and weight loss. Hepatomegaly is frequently found.[academic.oup.com]
  • Bones and joints - TB can get into a bone or joint, causing bone pain (for example, in the spine) or pain and swelling in a joint. Heart - TB sometimes causes inflammation around the heart, with chest pain or shortness of breath.[patient.info]
  • Symptoms depend on the affected areas of the body and can include: Abdominal pain or swelling Chills Cough and shortness of breath Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Joint pain Pale skin due to anemia (pallor) Sweating[medlineplus.gov]
Weight Loss
  • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal pain, weight[basicmedicalkey.com]
  • loss Weakness and fatigue Chills, night sweats are common Cough Hemoptysis Anorexia Hepatomegaly and lymphadenopathy are common Imaging Findings Takes weeks between the time of dissemination and the radiographic appearance of disease Up to 30% have a[learningradiology.com]
  • The most common symptoms were fever and weight loss. Risk factors were present in 70% of cases, mainly diabetes mellitus, history of prior tuberculosis, chronic liver and renal disease, immunosuppressive drug therapy and malignancy.[ingentaconnect.com]
  • They include weight loss, fever, chills, weakness, general discomfort, and difficulty breathing. Infection of the bone marrow may cause severe anemia and other blood abnormalities, suggesting leukemia.[merckmanuals.com]
  • Symptoms of the disease are commonly non-specific and include fever, vague abdominal pain, anorexia and weight loss [ 8 ].[hepatitis.imedpub.com]
Chills
  • Group of Hospitals, Bikaner with complaints of diarrhoea, fever with chills and rigor, pain in the abdomen and a swelling in the right hypochodrium for 40 days. The onset was gradual with increasing weakness and deterioration of the general health.[jpgmonline.com]
  • […] meningitis Risk Factors Immunosuppression Cancer Transplantation HIV Malnutrition Diabetes Silicosis End-stage renal disease Clinical Findings Onset is insidious Patients may not be acutely ill Symptoms include Fever and weight loss Weakness and fatigue Chills[learningradiology.com]
  • They include weight loss, fever, chills, weakness, general discomfort, and difficulty breathing. Infection of the bone marrow may cause severe anemia and other blood abnormalities, suggesting leukemia.[merckmanuals.com]
  • Symptoms depend on the affected areas of the body and can include: Abdominal pain or swelling Chills Cough and shortness of breath Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Joint pain Pale skin due to anemia (pallor) Sweating[medlineplus.gov]
  • The signs and symptoms exhibited by Disseminated Tuberculosis depend on the part of the body affected and may include: Persistent cough that can be blood-tinged Fatigue for a prolonged time period Fever that can be mild or severe, sweating, and chills[dovemed.com]
Abdominal Pain
  • The most common clinical findings are abdominal pain, fever and weight loss. Hepatomegaly is frequently found.[academic.oup.com]
  • Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal[basicmedicalkey.com]
  • Symptoms of the disease are commonly non-specific and include fever, vague abdominal pain, anorexia and weight loss [ 8 ].[hepatitis.imedpub.com]
  • pain, 4 all those were present in our case.[elsevier.pt]
  • Symptoms depend on the affected areas of the body and can include: Abdominal pain or swelling Chills Cough and shortness of breath Fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Joint pain Pale skin due to anemia (pallor) Sweating[medlineplus.gov]
Vomiting
  • She had developed abdominal pain, yellowish discoloration of urine and sclera 3 days back along with non-projectile vomiting, constipation and oliguria for last 2 days.[academic.oup.com]
  • Case presentation A 30-year-old man of Asian origin, presented to the surgery outpatient department (OPD) with non-radiating pain in the right hypochondrium and epigastrium associated with vomiting, intermittent fever with chills and rigors for 10 days[jmedicalcasereports.biomedcentral.com]
  • Being sick (vomiting). Fits (convulsions). Drowsiness. A change in behaviour. Skin - TB can cause certain rashes, including erythema nodosum - a red, lumpy rash on the legs - or lupus vulgaris which gives lumps or ulcers.[patient.info]
  • Rifampicin, pyrazinamide, isoniazid, ethionamide and PAS are all hepatotoxic drugs. [8 ] It manifests clinically as symptoms of jaundice, nausea, vomiting and abdominal pain or as raised bilirubin and hepatic transaminases levels.[tropicalgastro.com]
Loss of Appetite
  • But the common symptoms include fatigue, weight loss, loss of appetite, and fever.[dovemed.com]
  • […] suspicion, radiography and other medical and diagnostic evaluations suggestive of TB disease. 14 Sometimes, clinical diagnosis of tuberculosis is confirmed only after complete recovery due to antituberculous therapy. 5 The patient's low-grade fever, loss[elsevier.pt]
Hepatomegaly
  • ( ) patients Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly[basicmedicalkey.com]
  • He was alert but appeared uncomfortable, had mild jaundice and moderate tenderness in the right upper abdomen with palpable hepatomegaly.[elsevier.pt]
  • Transplantation HIV Malnutrition Diabetes Silicosis End-stage renal disease Clinical Findings Onset is insidious Patients may not be acutely ill Symptoms include Fever and weight loss Weakness and fatigue Chills, night sweats are common Cough Hemoptysis Anorexia Hepatomegaly[learningradiology.com]
  • Hepatomegaly is frequently found. The laboratory investigations frequently show an increase in alkaline phosphatase, with normal to mildly increased transaminases, anemia, hypoalbuminemia, hypergammaglobulinaemia and hyponatremia [ 4 ].[academic.oup.com]
  • He was treated with folic acid and ferrous sulphate for iron deficiency anaemia but in view of hepatomegaly and massive splenomegaly and hypersplenism, he was referred to surgeons for elective splenectomy.[jpma.org.pk]
Jaundice
  • Abstract Tuberculosis of the liver with jaundice is rare. 1-6 Four cases will be presented with the results of streptomycin therapy.[annals.org]
  • There was no jaundice, no clubbing of forgers, no lymphadenopathy and oedema of the feet.[jpgmonline.com]
  • He was alert but appeared uncomfortable, had mild jaundice and moderate tenderness in the right upper abdomen with palpable hepatomegaly.[elsevier.pt]
  • Jaundice is a very rare manifestation of TLA and may be caused by extra- or intrahepatic obstruction. No clear relationship exists between the degree of liver involvement and jaundice [ 10 ].[jmedicalcasereports.biomedcentral.com]
  • Similarly, isolated hepatic tuberculosis presenting as jaundice and abdominal distension has been reported in literature by Shastri et al . [ 9 ] However, hepatic TB presenting as acute liver failure has not been reported in literature.[academic.oup.com]
Tachycardia
  • Electrocardiogram showed sinus tachycardia, abdominal ultrasonography revealed hepatomegaly and slightly coarse echotexture of the liver, suggesting hepatic steatosis and chest X-ray revealed only a small left pleural effusion.[elsevier.pt]
  • On examination, patient was drowsy; her BP was 102/70 mmHg but had tachycardia. She had pallor, icterus and ecchymotic patches on the trunk and extremities. On CNS examination Glasgow coma score was 6/15, neck rigidity and kernig's sign was absent.[academic.oup.com]
  • His vitals revealed a fever of 102 F, tachycardia, and tachypnea with an oxygen saturation of 92%. His head computed tomography was negative for any acute abnormalities, and an electroencephalogram was negative for any epileptiform activities.[jtd.amegroups.com]
Ulcer
  • B19 ) tuberculous A18.83 Tuberculosis, tubercular, tuberculous (calcification) (calcified) (caseous) (chromogenic acid-fast bacilli) (degeneration) (fibrocaseous) (fistula) (interstitial) (isolated circumscribed lesions) (necrosis) (parenchymatous) (ulcerative[icd10data.com]
  • Indian J Tuberc 41:131 Bristowe JS (1958) On the connection between abscess of the liver and gastrointestinal ulceration Trans Path Soc 9:241-252 Hayashi M, YamawakiIokajima K, Tomimatsu M, Ohkawa S (2004) Tuberculous liver abscess not associated with[hepatitis.imedpub.com]
  • View Article Google Scholar Bristowe JS: On the connection between abscess of the liver and gastrointestinal ulceration. Trans Path Soc. 1958, 9: 241-252.[jmedicalcasereports.biomedcentral.com]
  • Skin - TB can cause certain rashes, including erythema nodosum - a red, lumpy rash on the legs - or lupus vulgaris which gives lumps or ulcers.[patient.info]
Neglect
  • Control of TB in children often has been neglected because children are ineffective transmitters of the bacillus and frequently escape the attention of TB control programs.[pedsinreview.aappublications.org]

Workup

  • Although most patients can be diagnosed based on sputum examination alone, a significant proportion need additional workup. Miliary tuberculosis is one such problem.[lungindia.com]
Enlargement of the Liver
  • The physical examination may reveal the following: Enlarged liver and spleen Swollen lymph nodes The TB skin test, also known as purified protein derivative (PPD) test or tuberculin test The skin test involves an injection of a small amount of tuberculin[dovemed.com]
Entamoeba Histolytica
  • Amebiasis is endemic in India and antibodies may appear even in non-invasive infections of Entamoeba histolytica and may persist years after clinical cure.[jmedicalcasereports.biomedcentral.com]
Pancreatic Necrosis
  • necrosis, unrelated to acute pancreatitis Atrophy of pancreas Calculus of pancreas Cirrhosis of pancreas Fibrosis of pancreas Pancreatic fat necrosis, unrelated to acute pancreatitis Pancreatic infantilism Pancreatic necrosis NOS, unrelated to acute[icd10data.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • Collection of Medical Illustrations (the CIBA "Green Books") has been expanded and revised to capture current perspectives in hepatology, pancreatology, and gastroenterology - from normal anatomy and physiology through pathophysiology, diagnostics and treatment[books.google.com]
  • Steroid treatment Steroid treatment ( prednisolone ) is recommended as an additional treatment for some forms of TB.[patient.info]
  • […] regimen and to increase the duration of treatment.[tropicalgastro.com]
  • All forms of TB and exposure need prompt evaluation and treatment. TB is a preventable disease, even in those who have been exposed to an infected person.[medlineplus.gov]

Prognosis

  • What is the Prognosis of Disseminated Tuberculosis? (Outcomes/Resolutions) With early diagnosis and prompt treatment, the prognosis of Disseminated Tuberculosis is generally good.[dovemed.com]
  • […] usually involved as part of disseminated TB • Most common symptoms overall are hepatomegaly, fever, abdominal pain, weight loss • Tuberculoma/localized disease can mimic neoplasm and compress biliary tract, vessels • Mortality ranges from 10-40% Worse prognosis[basicmedicalkey.com]
  • Treatment may continue for 6-9 months 9-12 months with meningeal involvement Complications Dissemination via bloodstream to Lymph nodes Liver Spleen Skeleton Kidneys Adrenals Prostate Seminal vesicles Epididymis Fallopian tubes Endometrium Meninges Prognosis[learningradiology.com]
  • The prognosis in such cases is goods We are thankful to the Principal and Controller, S.P. Medical College and Associated Group of Hospitals, Bikaner, for permitting us to publish this case report. 1. Gracey, L.: Tuberculous abscess of the liver.[jpgmonline.com]
  • All the above complications were noticed or suspected in our patient, which made his prognosis very guarded.[jtd.amegroups.com]

Etiology

  • Hepatic TB seen in 1% of patients with active TB More common in HIV( ) patients Etiology/Pathogenesis • Transmission typically by inhalation Can reach liver by hematogenous spread or direct spread from GI tract Clinical Issues • Liver is usually involved[basicmedicalkey.com]
  • […] biopsy was performed and histopathological examination ( Fig. 4 ) showed a diffuse and predominantly mononuclear cell infiltrate and epithelioid granulomas with central caseating necrosis suggestive of granulomatous hepatic inflammation of tuberculous etiology[elsevier.pt]
  • (Etiology) Disseminated Tuberculosis is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system It is caused by Mycobacterium tuberculosis, a pathogenic bacterium The infection is acquired[dovemed.com]
  • In a study from western India, a total of 280 consecutive patients with tuberculosis were evaluated prospectively for the etiology and pattern of liver involvement.[tropicalgastro.com]

Epidemiology

  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and[ingentaconnect.com]
  • Delineate the epidemiologic risk factors for the acquisition of TB infection, the subsequent development of TB disease in a minority of children, and the risk of multidrug-resistant TB. Describe the presenting signs and symptoms of TB in children.[pedsinreview.aappublications.org]
  • Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis 1990;12:583-90. BIEHL JP. Miliary tuberculosis; a review of sixty-eight adult patients admitted to a municipal general hospital.[jtd.amegroups.com]
  • Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis 1990;12:583-590. [ PUBMED ] 10. Mert A, Bilir M, Tabak F, Ozarus R, Ozturk R, Senturk H, et al.[lungindia.com]
  • Udani PM, Bhat US, Bhave SK, Ezuthachan SG, Shetty VV (1976) Problem of tuberculosis in children in India epidemiology, morbidity, mortality and control programme. Indian Pediatr 13: 881-890.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • This book in The Netter Collection of Medical Illustrations (the CIBA "Green Books") has been expanded and revised to capture current perspectives in hepatology, pancreatology, and gastroenterology - from normal anatomy and physiology through pathophysiology[books.google.com]

Prevention

  • Seite 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. ‎[books.google.de]
  • Disseminated TB can be prevented by early diagnosis and treatment of pulmonary tuberculosis.[dovemed.com]
  • TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing for TB is used in high-risk populations or in people who may have been exposed to TB, such as health care workers.[medlineplus.gov]
  • How can tuberculosis be prevented? TB is both preventable and treatable. It is a tragedy that it remains one of the biggest killers worldwide.[patient.info]
  • Describe the measures that can be taken to prevent the development of disease and to limit spread of TB within the community and the health-care setting.[pedsinreview.aappublications.org]

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