Isolated Hepatosplenic Tuberculosis: A Rare Case Report

Background: Tuberculosis is common in Bangladesh. It rarely involves the liver and spleen and when it does so, it is usually associated with disseminated disease. Method: We report a patient with isolated tuberculosis of the liver and spleen. Results: A 55 years old female presented with fever with chill and rigor and upper abdominal pain. USG revealed multiple hypoechoic lesions with central echogenicity in liver and spleen. CT scan showed multiple hypo density lesions in the liver and spleen. AFP, CEA and CA-19-9 were normal. As temperature was not subsided with antibiotics, pus from liver and spleen was aspirated and sent for gram and AFB stain, C/S, malignant cell, and Gene Xpert. All but Gene Xpert reports were negative. A detailed workup failed to identify other focus of tuberculosis. CAT-1 Anti tubercular started and the fever subsided. The patient gained weight on the subsequent follow up. Conclusion: Tuberculosis should also be considered in the differential diagnosis for multiple nodules in the liver and spleen along with other diagnosis, though it is rare. Gene X pert is a good diagnostic tool.