Hu Na, Wu Yuhui, Tang Maowen, Luo Tianyong, Yuan Shengmei, Li Cai, Lei Pinggui
Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Front Med (Lausanne). 2022 Nov 15;9:1005680. doi: 10.3389/fmed.2022.1005680. eCollection 2022.
Hepatic tuberculosis (TB), which is secondary to post-hepatitis B cirrhosis, is extremely rare. We report the case of a 69-year-old man with post-hepatitis B cirrhosis complicated by primary isolated hepatic TB who was initially misdiagnosed as having hepatocellular carcinoma (HCC). The patient was hospitalized with complaints of 2 weeks of fever. He had a 20-year history of post-hepatitis B cirrhosis. The laboratory tests suggested that his serum alpha-fetoprotein (AFP) level was markedly elevated to 1210 ng/ml. From the abdominal ultrasound (US) and magnetic resonance imaging (MRI) images, we confirmed the presence of cirrhosis and discovered a space-occupying lesion of the hepatic left lobe as well as portal vein-filling defects. These results led us to consider primary liver cancer and portal vein tumor thrombus combined with decompensated cirrhosis. Biopsy and histology may be considered the ultimate diagnostic tests, but we excluded needle biopsy because of his high risk of bleeding, in addition, the patient declined the procedure. To cope with his fever, the patient was given broad-spectrum antibiotic treatment initially, followed by intravenous vancomycin. After antibiotic treatment had failed, the patient was treated with anti-TB for 10 days; after that, the patient maintained a normal temperature. The patient continued to receive tuberculostatic therapy for 6 months following his discharge. AFP completely returned to the normal level, and the aforementioned mass disappeared. Finally, hepatic TB secondary to post-hepatitis B cirrhosis with portal vein thrombosis (PVT) was considered to be the final diagnosis. More than two imaging techniques discover a space-occupying liver lesion and that the serum alpha-fetoprotein (AFP) level is extremely elevated, which means that hepatocellular carcinoma (HCC) could be diagnosed. However, some exceedingly rare diseases should not be excluded. This case illustrated that the non-invasive diagnostic criteria for liver cancer should be considered carefully when discovering a space-occupying liver lesion in a patient with cirrhosis and an elevated AFP level. In addition, primary hepatic TB should be considered and included in the differential diagnosis, and a biopsy should be performed promptly.
继发于乙型肝炎后肝硬化的肝结核极为罕见。我们报告一例69岁男性，患有乙型肝炎后肝硬化并伴有原发性孤立性肝结核，最初被误诊为肝细胞癌（HCC）。该患者因发热2周入院。他有20年乙型肝炎后肝硬化病史。实验室检查显示其血清甲胎蛋白（AFP）水平显著升高至1210 ng/ml。通过腹部超声（US）和磁共振成像（MRI）图像，我们确认存在肝硬化，并发现肝左叶有占位性病变以及门静脉充盈缺损。这些结果使我们考虑原发性肝癌并门静脉肿瘤血栓合并失代偿性肝硬化。活检和组织学检查可被视为最终诊断手段，但由于患者出血风险高，我们排除了穿刺活检，此外，患者也拒绝了该操作。为应对发热，患者最初接受了广谱抗生素治疗，随后静脉注射万古霉素。抗生素治疗无效后，患者接受了10天抗结核治疗；此后，患者体温恢复正常。出院后，患者继续接受抗结核治疗6个月。AFP完全恢复正常水平，上述肿块消失。最终，诊断为继发于乙型肝炎后肝硬化并伴有门静脉血栓形成（PVT）的肝结核。两种以上成像技术发现肝脏占位性病变且血清甲胎蛋白（AFP）水平极度升高，意味着可诊断为肝细胞癌（HCC）。然而，一些极为罕见的疾病也不应被排除。该病例表明，在肝硬化且AFP水平升高的患者中发现肝脏占位性病变时，应谨慎考虑肝癌的非侵入性诊断标准。此外，应考虑原发性肝结核并将其纳入鉴别诊断，且应及时进行活检。
