A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response

Tae Kyung Kim; Cheol Woong Choi; Jong Kun Ha; Hyung Ha Jang; Su Bum Park; Hyung Wook Kim; Dae Hwan Kang

doi:10.4166/kjg.2013.62.1.64

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Kim, Choi, Ha, Jang, Park, Kim, and Kang: A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response

Case Report

Korean J Gastroenterol 2013;62(1):64-68.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.1.64

A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response

Tae Kyung Kim, Cheol Woong Choi, Jong Kun Ha, Hyung Ha Jang, Su Bum Park, Hyung Wook Kim, Dae Hwan Kang

Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence to: Cheol Woong Choi, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82-55-360-1535, Fax: +82-55-360-1536, E-mail: luckyace@hanmail.net

Received 30 August 20129 January 2013 Accepted 9 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after antituberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diasnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial antituberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing antituberculous treatment regimen.

Keywords: Paradoxical response, Tuberculous liver abscess, Tuberculous peritonitis

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Fig. 1.

(A) Initial pelvic CT before antituberculosis therapy showed a lot of ascites and omental smudge (arrow). (B) Follow-up CT 2 months after starting antituberculosis therapy showed decrease of ascites and omental smudge (arrow).

Fig. 2.

Gross findings through the laparoscope. Diffuse whitish nodules with ascites were noted on the peritoneum.

Fig. 3.

Microscopic findings of the peritoneum. Multinucleated giant cell and chronic granulomatous inflammation with caseous necrosis was noted (H&E, ×200).

Fig. 4.

(A) After treatment for 2 months, a new small low-attenuation nodule was noted on subcapsular area of the S5 segment (arrow). (B) After treatment for 6 months, the size of lesion increased (arrow). (C) After treatment for 13 months, the lesion disappeared (arrow).

Fig. 5.

Microscopic findings of the liver. The specimen showed chronic granulomatous inflammation with caseous necrosis (H&E, ×100).

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