Almalaq Abdulrahman A, Kardaman Hisham M, Mohammad Fuad H, Alzahrani Majed S, Al Masri Nasser M
Gastroenterology and Hepatology, Prince Sultan Military Medical City, Riyadh, SAU.
Hepatology, Prince Sultan Military Medical City, Riyadh, SAU.
Cureus. 2025 Sep 9;17(9):e91940. doi: 10.7759/cureus.91940. eCollection 2025 Sep.
Brucellosis is a zoonotic infection that can present with a wide range of systemic manifestations. Hepatic involvement is usually mild; however, in rare cases, it can result in focal lesions such as brucellar microabscesses or brucellomas. These may closely mimic hepatic malignancies or other infectious etiologies on imaging, particularly in patients with underlying chronic liver disease, posing a significant diagnostic challenge. We report the case of a 55-year-old Saudi male with a history of type 2 diabetes mellitus, hypertension, and cirrhosis secondary to metabolic dysfunction-associated steatotic liver disease (MASLD), who presented with hematemesis and intermittent fever. Laboratory findings revealed elevated aminotransferases, raised inflammatory markers, and positive serology for . Imaging demonstrated multiple small ring-enhancing hepatic lesions, initially raising concern for malignancy or disseminated infection. PET-CT showed no hypermetabolic activity, making malignancy less likely. A liver biopsy confirmed advanced fibrosis consistent with cirrhosis, without evidence of malignancy or organized abscess formation. Given the clinical and radiologic context, a multidisciplinary team initiated antimicrobial therapy with gentamicin for two weeks, in combination with doxycycline and trimethoprim-sulfamethoxazole for three months. Follow-up imaging showed significant resolution of the hepatic lesions. This case highlights the diagnostic complexity of hepatic brucellosis in cirrhotic patients, where radiological findings may mimic hepatocellular carcinoma or metastases. Despite advancements in imaging, definitive diagnosis often requires histologic confirmation and clinical correlation. The case underscores the importance of considering brucellosis in the differential diagnosis of hepatic lesions, especially in endemic regions or in patients with exposure risk factors. Early diagnosis and appropriate antimicrobial therapy can lead to complete resolution and avoid unnecessary interventions for presumed malignancy.
布鲁氏菌病是一种人畜共患感染病，可表现出广泛的全身症状。肝脏受累通常较轻；然而，在罕见情况下，它可导致局灶性病变，如布鲁氏菌微脓肿或布鲁氏瘤。这些病变在影像学上可能与肝脏恶性肿瘤或其他感染病因极为相似，尤其是在患有潜在慢性肝病的患者中，这构成了重大的诊断挑战。我们报告一例55岁沙特男性病例，该患者有2型糖尿病、高血压病史，继发于代谢功能障碍相关脂肪性肝病（MASLD）的肝硬化，出现呕血和间歇性发热。实验室检查结果显示转氨酶升高、炎症标志物升高以及布鲁氏菌血清学阳性。影像学检查显示肝脏有多个小的环形强化病变，最初令人担心是恶性肿瘤或播散性感染。PET-CT显示无高代谢活性，使恶性肿瘤的可能性降低。肝脏活检证实为与肝硬化一致的晚期纤维化，无恶性肿瘤或有组织的脓肿形成证据。鉴于临床和放射学情况，多学科团队开始用庆大霉素进行为期两周的抗菌治疗，并联合强力霉素和甲氧苄啶-磺胺甲恶唑治疗三个月。随访影像学检查显示肝脏病变明显消退。该病例突出了肝硬化患者肝脏布鲁氏菌病的诊断复杂性，其影像学表现可能酷似肝细胞癌或转移瘤。尽管影像学有了进展，但明确诊断通常仍需要组织学证实和临床关联。该病例强调了在肝脏病变的鉴别诊断中考虑布鲁氏菌病的重要性，特别是在流行地区或有暴露危险因素的患者中。早期诊断和适当的抗菌治疗可导致完全消退，并避免对疑似恶性肿瘤进行不必要的干预。
