Disseminated Tuberculosis Presenting as Multiple Hepatic and Splenic Abscesses with Associated Lymphadenopathy in an Immunocompetent Patient: A Case Report
Bassem Al Hariri, Nabil Mahmood, Rayan Elmubarak Eltayeb, Joudi Alhariri, Ahmad Eid Nazzal Alharafsheh, Anas Sheikh Al Ard KhanjiAbstract
Background
Hepatosplenic tuberculosis presenting as macroscopic abscesses is rare, particularly in immunocompetent individuals without pulmonary involvement.
Case presentation
A 31-year-old Ethiopian man living in Qatar presented with one week of fever and right upper quadrant pain. Investigations showed normocytic anaemia, elevated C-reactive protein (121.9 mg/L), and hypoalbuminaemia. Abdominal ultrasound and MRI revealed multiple liver and splenic lesions with retro crural and periportal lymphadenopathy. Broad-spectrum antibiotics were started. Ultrasound-guided drainage of the largest hepatic abscess yielded purulent fluid; PCR identified Mycobacterium tuberculosis complex DNA without rifampicin resistance. Acid-fast bacilli were negative on smear, and conventional mycobacterial cultures did not grow M. tuberculosis. Anti-tubercular therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) led to rapid clinical improvement.
Conclusion
Disseminated tuberculosis should be considered in the differential diagnosis of hepatosplenic lesions, even in immunocompetent patients without pulmonary symptoms. Molecular testing of abscess aspirate enables prompt diagnosis and treatment.