Chronic Liver Disease Association with Extrapulmonary Tuberculosis: Clinical and Histopathological Presentation- A Case Report

Tisankhe Zulu; Chanda Chalela; Johnny K. Chanshi; Webby Chanda; Champo Chewe; Kennedy Gondwe; Samuel Phiri; Christopher Nyirenda

doi:10.36437/irmhs.2021.4.3.A

Tisankhe Zulu Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.
Chanda Chalela Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.
Johnny K. Chanshi Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.
Webby Chanda Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.
Champo Chewe Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.
Kennedy Gondwe Department of Internal Medicine, Kitwe Teaching Hospital/Copper belt University, Kitwe, Zambia.
Samuel Phiri Arthur Davison Children’s Teaching Hospital/Copper belt University, Ndola, Zambia.
Christopher Nyirenda Department of Internal Medicine, Ndola Teaching Hospital/Copper belt University, Ndola, Zambia.

DOI: https://doi.org/10.36437/irmhs.2021.4.3.A

Keywords: Extrapulmonary Tuberculosis, TB-abdomen, Chronic Liver Disease, Ascites, Anti-tuberculosis Treatment.

Abstract

Chronic liver disease (CLD) is a result of progressive deterioration of liver functionality over a period of more than six months. There has been an increase in the burden of the disease in the Sub-Saharan region by 57% in the past 20 years. Zambia is estimated to have a chronic liver disease death rate of approximately 26.02 per 100,000 population. One of the established etiological factors in CLD are infections and there is an association between chronic liver disease and tuberculosis infection. Extrapulmonary tuberculosis (EPTB) has of recent times been increasing due to the increased prevalence of AIDS and immunosuppressive therapies.

We report a case of a 34year old HIV-negative woman who presented with a history of progressive abdominal distension, abdominal fullness and generalized abdominal pain, anorexia, weight loss, night sweats, and a history of drinking alcohol with no significant past medical history. Abdominal ultrasound showed hyper-echogenicity of the liver parenchyma. Inguinal lymph node biopsy showed caseating granulomatous inflammation and Langerhans giant cells but no malignant cells. A histological diagnosis of tuberculosis (TB) was made and after initiation of ATT the patient responded well.

Making the correct diagnosis of chronic liver disease in the TB abdomen may be challenging. Physicians therefore must be aware of the disease and its behavior especially in high-risk patients and of the current diagnostic limitation. A combination of the high level of suspicion, microbiologic, radiologic and histopathological examinations help achieve diagnostic accuracy and prevent a delay in treatment which is associated with increased mortality and morbidity in patients with this disease.