A Case Report of Primary Hepatosplenic Tuberculosis in an Immuno Competent Adult

Primary hepatosplenic tuberculosis is a rare disease, even in endemic areas the diagnosis can be challenging, as it can mimic other infections or neoplastic causes. We describe a rare case of a 50-year-old man with no medical history presented to our unit for exploration of weight loss and chronic abdominal pain. A contrast-enhanced CT scan of the abdomen showed multiple hypodense hepatics and splenic nodules, not enhanced after injection of the contrast; the liver is infiltrated with irregular edges and perfusion disturbances, giving an encephalic appearance. The histological examination of an ultrasound-guided percutaneous liver biopsy showed an epithelio-gigantocellular granuloma without caseating necrosis. However, the PCR test and the Quantiferon-TB Gold test returned positive. The patient was treated with quadruple therapy (ethambutol, rifampicin, isoniazid and pyrazynamide) for two months, then rifampicin and isoniazid for seven months. At the six-month follow-up after stopping treatment, the patient was asymptomatic, and the hepatosplenic lesions had disappeared on a follow-up CT scan.

Conclusion: Hepatosplenic tuberculosis is possible in a suggestive clinical and epidemiological context, even in an immunocompetent adult.