Intestinal Tuberculosis Associated with Macronodular Hepatic Tuberculosis: Report of a Case

Abdominal tuberculosis (TB) manifested as intestinal TB with hepatic macronodular pattern has been rare in the past. However, with the resurgence in the rate of TB and the prevalence of human immunodeficiency virus infection, the incidence of abdominal TB has increased recently. We report a 72-year-old male patient admitted due to poor appetite, nausea, vomiting and abdominal distension for 2 weeks and intermittent lower abdominal cramping pain for one day. On admission, abdominal sonography revealed a 3.5 cm sized hypoechoic mass with hyperechoic component at the segment Ⅱ of liver. Computed tomographic scan of abdomen showed abnormal wall thickening of ileocecal valve and terminal ileum. Moreover, a 4×3.5 cm sized, calcified hypodense lesion was found at the segment Ⅱ of liver. The patient received right hemicolectomy as well as hepatectomy of segment Ⅱ and Ⅲ successfully. Chronic granulomatous inflammation with positive acid-fast stain was found in both liver and colon specimens. With the consideration of vague symptoms and signs of abdominal TB, this case reminds us that a high index of suspicion is needed to make an accurate diagnosis to avoid unnecessary morbidity and mortality.