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Kanthawang T, Pattamapaspong N, Peh WCG, Hammami N, Bouaziz MC, Ladeb MF. Imaging of infra-thoracic tuberculosis. Br J Radiol 2024; 97:492-504. [PMID: 38288505 DOI: 10.1093/bjr/tqad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024] Open
Abstract
Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis 1007, Tunisia
| | - Mouna Chelli Bouaziz
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
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2
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Chen J, Yang Q, Wang C. Multiple Hepatic Masses in a Patient With Crohn's Disease. Gastroenterology 2024; 166:e20-e23. [PMID: 37739090 DOI: 10.1053/j.gastro.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Jintong Chen
- Department of Gastroenterology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China; Department of Gastroenterology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qinyu Yang
- Department of Gastroenterology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China
| | - Chengdang Wang
- Department of Gastroenterology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China; Department of Gastroenterology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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3
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Das CJ, Rednam N, Vora Z, Aggarwal A, Chandrashekhara SH, Kundra V. Abdominal visceral tuberculosis: a malignancy mimic. Abdom Radiol (NY) 2023; 48:2705-2715. [PMID: 37204509 PMCID: PMC10197054 DOI: 10.1007/s00261-023-03939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response.
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Affiliation(s)
- Chandan J. Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Zainab Vora
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Ankita Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - S. H. Chandrashekhara
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
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4
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Hu N, Wu Y, Tang M, Luo T, Yuan S, Li C, Lei P. Case report: Hepatic tuberculosis mimicking hepatocellular carcinoma in a patient with cirrhosis induced by hepatitis B virus. Front Med (Lausanne) 2022; 9:1005680. [PMID: 36457572 PMCID: PMC9705775 DOI: 10.3389/fmed.2022.1005680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
Hepatic tuberculosis (TB), which is secondary to post-hepatitis B cirrhosis, is extremely rare. We report the case of a 69-year-old man with post-hepatitis B cirrhosis complicated by primary isolated hepatic TB who was initially misdiagnosed as having hepatocellular carcinoma (HCC). The patient was hospitalized with complaints of 2 weeks of fever. He had a 20-year history of post-hepatitis B cirrhosis. The laboratory tests suggested that his serum alpha-fetoprotein (AFP) level was markedly elevated to 1210 ng/ml. From the abdominal ultrasound (US) and magnetic resonance imaging (MRI) images, we confirmed the presence of cirrhosis and discovered a space-occupying lesion of the hepatic left lobe as well as portal vein-filling defects. These results led us to consider primary liver cancer and portal vein tumor thrombus combined with decompensated cirrhosis. Biopsy and histology may be considered the ultimate diagnostic tests, but we excluded needle biopsy because of his high risk of bleeding, in addition, the patient declined the procedure. To cope with his fever, the patient was given broad-spectrum antibiotic treatment initially, followed by intravenous vancomycin. After antibiotic treatment had failed, the patient was treated with anti-TB for 10 days; after that, the patient maintained a normal temperature. The patient continued to receive tuberculostatic therapy for 6 months following his discharge. AFP completely returned to the normal level, and the aforementioned mass disappeared. Finally, hepatic TB secondary to post-hepatitis B cirrhosis with portal vein thrombosis (PVT) was considered to be the final diagnosis. More than two imaging techniques discover a space-occupying liver lesion and that the serum alpha-fetoprotein (AFP) level is extremely elevated, which means that hepatocellular carcinoma (HCC) could be diagnosed. However, some exceedingly rare diseases should not be excluded. This case illustrated that the non-invasive diagnostic criteria for liver cancer should be considered carefully when discovering a space-occupying liver lesion in a patient with cirrhosis and an elevated AFP level. In addition, primary hepatic TB should be considered and included in the differential diagnosis, and a biopsy should be performed promptly.
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Affiliation(s)
- Na Hu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tianyong Luo
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shengmei Yuan
- Department of Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Cai Li
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Pinggui Lei
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Soni S, Sreesanth KS, Varshney V, Swami A. Gall bladder tuberculosis: Review of literature. Indian J Tuberc 2022; 69:421-426. [PMID: 36460370 DOI: 10.1016/j.ijtb.2021.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 06/17/2023]
Abstract
Gall bladder tuberculosis (GB TB) is a very rare disease and scarce data is available on exact incidence and clinicopathogenesis even in endemic areas. The aim is to provide an insight into epidemiology, pathophysiology and management for better understanding of gall bladder tuberculosis. We collected data available from the literature on all histologically proven gall bladder tuberculosis. Case reports with either no article or only abstracts were available excluded from the study. Fifty two case reports and series with total 73 patients were included in this study. Mean age of patients was 48 years (Range 8-86 years) with male: female ratio of 1:1.7. 53 (73%) patient had isolated disease and 18 (24%) had associated abdominal tuberculosis. 3 (4%) of patients had concomitant and 7 (9%) had past history of pulmonary tuberculosis. 39 patients presented as cholecystitis and 25 as gall bladder mass. 44 (60%) patients had gall stones and majority of them (56%) are multiple. Granuloma and caseous necrosis was found in 80% & 60% of patients respectively. In conclusion, Gall bladder tuberculosis is a very uncommon presentation of abdominal tuberculosis. Pre-operative diagnosis is not possible due to lack of specific diagnostic test so increase in awareness and a high index of suspicious is required.
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Affiliation(s)
- Subhash Soni
- Department of Surgical Gastroenterology, AIIMS Jodhpur, Rajasthan, India.
| | - K S Sreesanth
- Department of Surgical Gastroenterology, AIIMS Jodhpur, Rajasthan, India
| | - Vaibhav Varshney
- Department of Surgical Gastroenterology, AIIMS Jodhpur, Rajasthan, India
| | - Ashish Swami
- Department of Surgical Gastroenterology, AIIMS Jodhpur, Rajasthan, India
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Krishna S, Mishra AK, Ravina M, Kashyap Y, Bansal H, Dasgupta S. Primary Biliary Tuberculosis Masquerading Cholangiocarcinoma in 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2022; 37:265-267. [PMID: 36686295 PMCID: PMC9855251 DOI: 10.4103/ijnm.ijnm_204_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
Hepatobiliary involvement is a less common manifestation of abdominal tuberculosis. We present the case of a 42-year-old female who presented with fever, abdominal pain, and jaundice of 2 months duration. 18F-fluorodeoxyglucose positron emission tomography/computed tomography done for disease evaluation suggested the likely possibility of cholangiocarcinoma but excision biopsy from periportal lymph node later confirmed a granulomatous etiology and she was successfully treated with antitubercular therapy.
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Affiliation(s)
- Sarin Krishna
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ajit Kumar Mishra
- Department of General Surgery, DKS Hospital, Raipur, Chhattisgarh, India
| | - Mudalsha Ravina
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yashwanth Kashyap
- Department of Medical Oncology, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Himanshu Bansal
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subhajit Dasgupta
- Department of Nuclear Medicine, AII India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Castillo Barradas M, Flores García NC. Nonviral Infections of the Liver in Developing Countries. Clin Liver Dis (Hoboken) 2022; 19:59-62. [PMID: 35308475 PMCID: PMC8912214 DOI: 10.1002/cld.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Interview and Audio Recording.
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Affiliation(s)
- Mauricio Castillo Barradas
- GastroenterologíaInstituto Mexicano del Seguro SocialHospital de Especialidades CMN La RazaMexico CityMexico
| | - Neyelli Cointa Flores García
- GastroenterologíaDepartamento de GastroenterologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
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8
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Kim JK, Park EJ, Jo EK. Itaconate, Arginine, and Gamma-Aminobutyric Acid: A Host Metabolite Triad Protective Against Mycobacterial Infection. Front Immunol 2022; 13:832015. [PMID: 35185924 PMCID: PMC8855927 DOI: 10.3389/fimmu.2022.832015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/13/2022] [Indexed: 12/29/2022] Open
Abstract
Immune metabolic regulation shapes the host-pathogen interaction during infection with Mycobacterium tuberculosis (Mtb), the pathogen of human tuberculosis (TB). Several immunometabolites generated by metabolic remodeling in macrophages are implicated in innate immune protection against Mtb infection by fine-tuning defensive pathways. Itaconate, produced by the mitochondrial enzyme immunoresponsive gene 1 (IRG1), has antimicrobial and anti-inflammatory effects, restricting intracellular mycobacterial growth. L-arginine, a component of the urea cycle, is critical for the synthesis of nitric oxide (NO) and is implicated in M1-mediated antimycobacterial responses in myeloid cells. L-citrulline, a by-product of NO production, contributes to host defense and generates L-arginine in myeloid cells. In arginase 1-expressing cells, L-arginine can be converted into ornithine, a polyamine precursor that enhances autophagy and antimicrobial protection against Mtb in Kupffer cells. Gamma-aminobutyric acid (GABA), a metabolite and neurotransmitter, activate autophagy to induce antimycobacterial host defenses. This review discusses the recent updates of the functions of the three metabolites in host protection against mycobacterial infection. Understanding the mechanisms by which these metabolites promote host defense will facilitate the development of novel host-directed therapeutics against Mtb and drug-resistant bacteria.
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Affiliation(s)
- Jin Kyung Kim
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, South Korea
- Infection Control Convergence Research Center, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Eun-Jin Park
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, South Korea
- Infection Control Convergence Research Center, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Eun-Kyeong Jo
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, South Korea
- Infection Control Convergence Research Center, Chungnam National University College of Medicine, Daejeon, South Korea
- *Correspondence: Eun-Kyeong Jo,
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9
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Abstract
BACKGROUND AND AIMS Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. METHODS AND MATERIAL We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. RESULTS The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan's giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. CONCLUSION HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. TRIAL REGISTRATION This is a retrospective and observational study hence clinical trial registration is not applicable.
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Wang TY, Lai HC, Chen HH, Wang ML, Hsieh MC, Chang CT, Chen RH, Ho CW, Hung YC, Tseng JY, Lin CL, Kao CH. Pyogenic Liver Abscess Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide, Population-Based Cohort Study. Front Med (Lausanne) 2021; 8:675345. [PMID: 34055845 PMCID: PMC8149939 DOI: 10.3389/fmed.2021.675345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background: To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide. Methods: We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively. Results: In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32-3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM <2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort. Conclusion: In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.
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Affiliation(s)
- Tzu-Yuan Wang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Chung Sheng Clinic, Nantou, Taiwan
| | - Mei-Lin Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Ming-Chia Hsieh
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chwen-Tzuei Chang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Rong-Hsing Chen
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Wei Ho
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Chin Hung
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Juei-Yu Tseng
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and Positron Emission Tomography (PET) Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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11
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Chapman NG, Dalton SC, Hore TA. Hepatobiliary tuberculosis: a notorious mimic to be considered within the differential diagnosis of cholangiocarcinoma. ANZ J Surg 2021; 91:E706-E707. [PMID: 33764616 DOI: 10.1111/ans.16752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Nicholas G Chapman
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Todd A Hore
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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12
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Ornithine-A urea cycle metabolite enhances autophagy and controls Mycobacterium tuberculosis infection. Nat Commun 2020; 11:3535. [PMID: 32669568 PMCID: PMC7363810 DOI: 10.1038/s41467-020-17310-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
Macrophages are professional phagocytes known to play a vital role in controlling Mycobacterium tuberculosis (Mtb) infection and disease progression. Here we compare Mtb growth in mouse alveolar (AMs), peritoneal (PMs), and liver (Kupffer cells; KCs) macrophages and in bone marrow-derived monocytes (BDMs). KCs restrict Mtb growth more efficiently than all other macrophages and monocytes despite equivalent infections through enhanced autophagy. A metabolomics comparison of Mtb-infected macrophages indicates that ornithine and imidazole are two top-scoring metabolites in Mtb-infected KCs and that acetylcholine is the top-scoring in Mtb-infected AMs. Ornithine, imidazole and atropine (acetylcholine inhibitor) inhibit Mtb growth in AMs. Ornithine enhances AMPK mediated autophagy whereas imidazole directly kills Mtb by reducing cytochrome P450 activity. Intranasal delivery of ornithine or imidazole or the two together restricts Mtb growth. Our study demonstrates that the metabolic differences between Mtb-infected AMs and KCs lead to differences in the restriction of Mtb growth. Kupffer cells are more resistant to M. tuberculosis when compared with alveolar macrophages. Here the authors show that this distinction is caused by the presence of ornithine and imidazole in Kupffer cells and that these metabolites can drive autophagy and M. tuberculosis killing in alveolar macrophages when given intranasally to infected mice.
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13
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Hoe VC, Khairuddin A, Tan JS, Sharif MS, Azizan N, Hayati F. Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report. BMC Surg 2020; 20:145. [PMID: 32605613 PMCID: PMC7325297 DOI: 10.1186/s12893-020-00806-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/23/2020] [Indexed: 01/29/2023] Open
Abstract
Background Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems. Case presentation A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB. Conclusions A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.
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Affiliation(s)
- Vee Chuan Hoe
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Allim Khairuddin
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Jun Sam Tan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | | | - Nornazirah Azizan
- Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
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14
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Eshiwe C, Shahi F, Gordon N, Lillie P. Rare and unusual case of hepatic and disseminated tuberculosis in an immunocompetent patient. BMJ Case Rep 2019; 12:12/6/e229384. [PMID: 31229981 DOI: 10.1136/bcr-2019-229384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.
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Affiliation(s)
- Celestine Eshiwe
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Farah Shahi
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Neil Gordon
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Patrick Lillie
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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15
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AL Umairi R, AL Abri A, Kamona A. Tuberculosis (TB) of the Porta Hepatis Presenting with Obstructive Jaundice Mimicking a Malignant Biliary Tumor: A Case Report and Review of the Literature. Case Rep Radiol 2018; 2018:5318197. [PMID: 30631628 PMCID: PMC6304509 DOI: 10.1155/2018/5318197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
Localized hepatobiliary tuberculosis (TB) is a rare disorder which can present with an obstructive jaundice mimicking other noninfectious causes such as cholangiocarcinoma. Here, we report a case of porta hepatis tuberculosis in 19-year-old female who presented with an obstructive jaundice, and her computed tomography (CT) of the abdomen revealed a hepatic hilar mass with radiological features mimicking a malignant biliary tumor. We also review the literature related to this disorder.
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Affiliation(s)
| | - Ahmed AL Abri
- Department of Radiology, The Royal Hospital, Muscat, Oman
| | - Atheel Kamona
- Department of Radiology, The Royal Hospital, Muscat, Oman
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16
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Malikowski T, Mahmood M, Smyrk T, Raffals L, Nehra V. Tuberculosis of the gastrointestinal tract and associated viscera. J Clin Tuberc Other Mycobact Dis 2018; 12:1-8. [PMID: 31720391 PMCID: PMC6830173 DOI: 10.1016/j.jctube.2018.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/10/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis involvement of the gastrointestinal tract, peritoneum, and associated viscera is an uncommon but well described entity. While peritoneal tuberculosis and tuberculous enteritis are more common, involvement of the esophagus, stomach, colon, rectum, anus, liver, bile ducts, gallbladder, and pancreas can occur. Diagnosis is challenging as cases often mimic neoplasm or inflammatory bowel disease. In this review we outline the pathogenesis, clinical presentation, diagnostic testing, and treatment strategies pertaining to such cases.
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Affiliation(s)
- Thomas Malikowski
- Department of Internal Medicine, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Thomas Smyrk
- Department of Anatomic Pathology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Vandana Nehra
- Division of Gastroenterology and Hepatology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
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17
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18
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Kritsaneepaiboon S, Andres MM, Tatco VR, Lim CCQ, Concepcion NDP. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 2017; 47:1249-1259. [PMID: 29052770 DOI: 10.1007/s00247-017-3867-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/23/2017] [Accepted: 04/09/2017] [Indexed: 12/17/2022]
Abstract
Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.
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Affiliation(s)
- Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Thailand.
| | - Mariaem M Andres
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Vincent R Tatco
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Cielo Consuelo Q Lim
- Institute of Radiology, St. Luke's Medical Center, 279 E. Rodriquez Sr. Boulevard, 1102, Quezon City, Philippines
| | - Nathan David P Concepcion
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
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19
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Narayan KS, Kumar M, Padhi S, Jain M, Ashdhir P, Pokharna RK. Tubercular biliary hilar stricture: A rare case report. Indian J Tuberc 2017; 65:266-267. [PMID: 29933873 DOI: 10.1016/j.ijtb.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/09/2017] [Indexed: 11/20/2022]
Abstract
Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.
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Affiliation(s)
- Kumar Shwetanshu Narayan
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Manoj Kumar
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Shivdutt Padhi
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Mukesh Jain
- Assistant Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Prachis Ashdhir
- Associate Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Rupesh Kumar Pokharna
- Senior Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India.
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20
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Unusual Presentation of Tubercular Liver Abscess in an Immune-Competent Adult. J Clin Exp Hepatol 2017; 7:77-79. [PMID: 28348476 PMCID: PMC5357715 DOI: 10.1016/j.jceh.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022] Open
Abstract
Isolated hepatobiliary tuberculosis (TB) has been uncommonly described with or without biliary involvement and accounts for less than 1% of all tubercular infections. Isolated hepatic TB is even rare and poses a great diagnostic challenge. We report a case of isolated tubercular liver abscess with extension into the chest wall in an immune-competent adult, which was diagnosed and managed successfully with antitubercular treatment.
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21
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22
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Miliary Tuberculosis Induced Acute Liver Failure. Case Rep Infect Dis 2015; 2015:759341. [PMID: 26435862 PMCID: PMC4575992 DOI: 10.1155/2015/759341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/21/2015] [Indexed: 11/25/2022] Open
Abstract
Hepatobiliary tuberculosis is uncommon even in endemic countries. It is associated with a high mortality and is even diagnosed early in the disease course. Acute liver failure (ALF) caused by tuberculosis bacilli has been reported in only a few reports. All previous cases have been diagnosed by postmortem examination. Time to antituberculosis treatment is very critical. In case of suggestive findings on clinical and radiologic examination, antituberculosis treatment should be initiated immediately. Drug use can be a challenge in patients with ALF. However, as long as the other possible causes of ALF can be excluded and hepatotoxic drugs were avoided during the early course of treatment, such a highly fatal presentation of tuberculosis can be treated safely. Here, we report a case of acute liver failure as a presentation of miliary tuberculosis. He was treated successfully with antituberculosis treatment.
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23
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da Rocha EL, Pedrassa BC, Bormann RL, Kierszenbaum ML, Torres LR, D'Ippolito G. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings. Radiol Bras 2015; 48:181-91. [PMID: 26185345 PMCID: PMC4492571 DOI: 10.1590/0100-3984.2013.1801] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis is a disease whose incidence has increased principally as a consequence
of HIV infection and use of immunosuppressive drugs. The abdomen is the most common
site of extrapulmonary tuberculosis. It may be confused with several different
conditions such as inflammatory bowel disease, cancer and other infectious diseases.
Delay in the diagnosis may result in significantly increased morbidity, and therefore
an early recognition of the condition is essential for proper treatment. In the
present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed
by means of computed tomography and magnetic resonance imaging, demonstrating the
involvement of different organs and systems, and presentations which frequently lead
radiologists to a diagnostic dilemma. A brief literature review was focused on
imaging findings and their respective prevalence.
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Affiliation(s)
- Eduardo Lima da Rocha
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Bruno Cheregati Pedrassa
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Renata Lilian Bormann
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Marcelo Longo Kierszenbaum
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lucas Rios Torres
- Fellow, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Professor at Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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24
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Ishibashi H, Yasuda I, Fukita Y. Multiple tumor-like lesions of the liver in a patient with a history of pancreaticoduodenectomy. Gastroenterology 2015; 148:e6-7. [PMID: 25450076 DOI: 10.1053/j.gastro.2014.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Hiroyuki Ishibashi
- Department of Gastroenterology, Seirei Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Ikuma Yasuda
- Department of Gastroenterology, Seirei Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Yosho Fukita
- Department of Gastroenterology, Seirei Yokohama General Hospital, Yokohama, Kanagawa, Japan
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25
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Hosford JD, von Fricken ME, Lauzardo M, Chang M, Dai Y, Lyon JA, Shuster J, Fennelly KP. Hepatotoxicity from antituberculous therapy in the elderly: a systematic review. Tuberculosis (Edinb) 2014; 95:112-22. [PMID: 25595441 DOI: 10.1016/j.tube.2014.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Elderly persons have the highest rates of tuberculosis (TB) in the United States compared to all other age groups. A systematic literature review was conducted to determine if older age was a risk factor for hepatotoxicity resulting from treatment with first-line drugs used to treat active (TB) and latent tuberculosis (LTBI). METHODS A systematic review of MEDLINE, Cochrane Controlled Trial Registry, CINAHL(®), and Science Citation Index Expanded (from 1970 to 2011) was performed to determine the risk of hepatotoxicity, comparing those over 60 with those under 60. A meta-analysis was performed using a random effects model along with log odds ratios and the chi-square test. FINDINGS Thirty-eight studies (40,034 participants; 1208 cases of hepatotoxicity) met the selection criteria. For active TB, an overall mean effect of 0.277 (p = 0.024, 95% CI: 0.037-0.517) was observed, which is equivalent to an odds ratio of 1.32 (95% CI: 1.04-1.68). For LTBI, an overall mean effect of 1.42 (p < 0.001, 95% CI: 0.794-2.05) was observed, which translates to an odds ratio of 4.14 (95% CI: 2.21-7.74). INTERPRETATION Our analysis revealed that patients older than 60 had significantly more risk of hepatotoxicity. These studies suggest that a gentler regimen of treatment for older individuals could benefit health outcomes in this population of TB patients and minimize risks to the public's health.
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Affiliation(s)
- Jennifer D Hosford
- Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Michael E von Fricken
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | - Michael Lauzardo
- Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Myron Chang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Jennifer A Lyon
- Biomedical and Health Information Services, University of Florida, Gainesville, FL, USA
| | - John Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Kevin P Fennelly
- Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
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26
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Baik SJ, Yoo K, Kim TH, Moon IH, Cho MS. A case of obstructive jaundice caused by tuberculous lymphadenitis: a literature review. Clin Mol Hepatol 2014; 20:208-13. [PMID: 25032188 PMCID: PMC4099337 DOI: 10.3350/cmh.2014.20.2.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/07/2012] [Accepted: 11/19/2012] [Indexed: 11/05/2022] Open
Abstract
Obstructive jaundice caused by tuberculous lymphadenitis is a rare manifestation of tuberculosis (TB), with 15 cases having been reported in Korea. We experienced a case of obstructive jaundice caused by pericholedochal tuberculous lymphadenitis in a 30-year-old man. The patient's initial serum total bilirubin level was 21.1 mg/dL. Abdominal computed tomography revealed narrowing of the bile duct by a conglomerated soft-tissue mass involving the main portal vein. Abrupt obstruction of the common bile duct was observed on cholangiography. Pathologic analysis of a ultrasonography-guided biopsy sample revealed chronic granulomatous inflammation, and an endoscopic examination revealed esophageal varices and active duodenal ulceration, the pathology of which was chronic noncaseating granulomatous inflammation. Hepaticojejunostomy was performed and pathologic analysis of the conglomerated soft-tissue mass revealed chronic granulomatous inflammation with caseation of the lymph nodes. Tuberculous lymphadenitis should be considered in patients presenting with obstructive jaundice in an endemic area.
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Affiliation(s)
- Su Jung Baik
- Department of Internal Medicine, Health Promotion Center, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Kwon Yoo
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Il Hwan Moon
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Woman's University School of Medicine, Seoul, Korea
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27
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Tuberculous choledochoduodenal fistula with extrahepatic portal vein obstruction: Rare association. J Formos Med Assoc 2013; 112:807-9. [DOI: 10.1016/j.jfma.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 09/27/2013] [Accepted: 10/12/2013] [Indexed: 01/16/2023] Open
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Abstract
Systemic causes of cholestasis constitute a diverse group of diseases across organ systems. The pathophysiology of cholestasis in systemic disease can be a consequence of direct involvement of a disease process within the liver or extrahepatic biliary system or secondary to immune-mediated changes in bile flow. Evaluating a patient with cholestasis for a systemic cause requires an understanding of the patient's risk factors, clinical setting (eg, hospitalized or immunosuppressed patient), clinical features, and pattern of laboratory abnormalities.
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Affiliation(s)
- Andrew S. deLemos
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Boston, MA 02115, USA
| | - Lawrence S. Friedman
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Boston, MA 02115, USA,Tufts University School of Medicine, Boston, MA 02111, USA,Department of Medicine, Newton-Wellesley Hospital, Newton, MA 02462, USA,Corresponding author. Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462.
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29
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Kwon JC, Kim SH, Park SH, Choi SM, Lee DG, Choi JH, Yoo JH, Kim YJ, Lee S, Kim HJ, Cho SG, Lee JW, Min WS. Clinical characteristics and the usefulness of the QuantiFERON-TB Gold In-Tube test in hematologic patients with hepatic or splenic lesions. Korean J Intern Med 2013; 28:187-96. [PMID: 23525889 PMCID: PMC3604609 DOI: 10.3904/kjim.2013.28.2.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/04/2012] [Accepted: 06/29/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Hepatic or splenic lesions in hematologic patients are not defined well because they are not easy to evaluate due to limitations of invasive procedures. Management typically depends on the clinical diagnosis with few microbiological data. METHODS We reviewed the medical records of consecutive hematologic patients with hepatic or splenic lesions in the infectious diseases unit from April 2009 to December 2010 at the Catholic Hematopoietic Stem Cell Transplantation Center in Korea. RESULTS Twenty-six patients were identified. Their mean age was 46.0 ± 14.7 years, and 16 (61.5%) were male. Underlying diseases were acute myelogenous leukemia (n = 15, 57.7%) and myelodysplastic syndrome (n = 6, 23.1%). Among the nine nontuberculous infectious lesions, two bacterial, six fungal, and one combined infection were identified. The numbers of confirmed, probable, and possible tuberculosis (TB) cases were one, three, and four, respectively. Two patients had concurrent pulmonary TB. QuantiFERON-TB Gold In-Tube (QFT-GIT, Cellestis Ltd.) was positive in seven cases, among which six were diagnosed with TB. The sensitivity and specificity of QFT-GIT were 75% and 81.3%. Nine (34.6%) were defined as noninfectious causes. CONCLUSIONS Causes of hepatic or splenic lesion in hematologic patients were diverse including TB, non-TB organisms, and noninfectious origins. TB should be considered for patients not responding to antibacterial or antifungal drugs, even in the absence of direct microbiological evidence. QFT-GIT may be useful for a differential diagnosis of hepatosplenic lesions in hematologic patients.
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Affiliation(s)
- Jae-Cheol Kwon
- Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Si-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Hong Yoo
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yoo-Jin Kim
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seok Lee
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hee-Je Kim
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seok-Goo Cho
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong-Wook Lee
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woo-Sung Min
- Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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30
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Lee WK, Van Tonder F, Tartaglia CJ, Dagia C, Cazzato RL, Duddalwar VA, Chang SD. CT appearances of abdominal tuberculosis. Clin Radiol 2011; 67:596-604. [PMID: 22212637 DOI: 10.1016/j.crad.2011.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/06/2011] [Indexed: 12/16/2022]
Abstract
The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.
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Affiliation(s)
- W-K Lee
- Department of Medical Imaging, University of Melbourne, Fitzroy, Victoria, Australia.
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31
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Abstract
The liver plays an important role in host defense against invasive microorganisms. The effect of microbial pathogens on the liver can vary greatly, presenting with a wide variety of manifestations from asymptomatic increases in aminotransaminases, acute liver failure, hepatic fibrosis, and cirrhosis. In evaluating the liver manifestations of a potential infectious pathogen, diagnosis of some of the less common infectious pathogens is dependent on a high level of suspicion and recognition of some of the key diagnostic clues. Successful diagnosis can only be accomplished through a careful history, including travel and exposures, physical examination, and appropriate microbiologic studies. This article reviews the involvement of the liver during systemic infections with organisms that are not considered to be primarily hepatotropic.
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Affiliation(s)
- Rohit Talwani
- Assistant Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Bruce L. Gilliam
- Associate Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Charles Howell
- Profesor of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
- Director of Hepatology Research University of Maryland School of Medicine, Baltimore, MD
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32
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Abstract
Chronic liver disease is associated with many pulmonary complications. Several, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax have been extensively reviewed. However, hepatobiliary manifestations of primary pulmonary diseases have received less attention. This review focuses on hepatobiliary complications of respiratory failure, cystic fibrosis, α-1 antitrypsin deficiency, sarcoidosis, and tuberculosis.
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Affiliation(s)
- Rajan Kochar
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA
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33
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Geri G, Cacoub P. [Hepatic granulomas]. Rev Med Interne 2010; 32:560-6. [PMID: 20832918 DOI: 10.1016/j.revmed.2010.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/29/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
Abstract
Liver granulomas are histopathologically defined and associated with various liver and non-livers disorders. There are five main causes of liver granulomatosis: primary biliary cirrhosis, tuberculosis, sarcoidosis, B and C viral hepatitis, and drug related. In the other cases, not associated with an underlying systemic granulomatous disease, a systematic diagnostic approach should be used to identify less common etiologies. After a careful diagnostic work-up, a long-term follow-up of patients with undetermined liver granulomatosis is mandatory as it may be a presenting feature of liver lymphoma.
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Affiliation(s)
- G Geri
- Service de Médecine Interne II, Université Pierre-et-Marie-Curie-Paris 6, CNRS, UMR 7087, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013 Paris cedex 13, France
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34
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Frederiksen HB, Kragstrup J, Dehlholm-Lambertsen B. Attachment in the doctor-patient relationship in general practice: a qualitative study. Scand J Prim Health Care 2010; 28:185-90. [PMID: 20642396 PMCID: PMC3442335 DOI: 10.3109/02813432.2010.505447] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/29/2010] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore why interpersonal continuity with a regular doctor is valuable to patients. DESIGN, SETTING, AND SUBJECTS A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory. RESULTS A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship. CONCLUSION Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.
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Affiliation(s)
- Heidi Bøgelund Frederiksen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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A Diagnostic Surprise. South Med J 2008; 101:344. [DOI: 10.1097/smj.0b013e318164de03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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