Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9310-9319
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9310
Isolated hepatic tuberculosis associated with portal vein thrombosis and hepatitis B virus coinfection: A case report and review of the literature
Shu-Mei Zheng, Ning Lin, Shan-Hong Tang, Jia-Yi Yang, Hai-Qiong Wang, Shu-Lan Luo, Yong Zhang, Dong Mu
Shu-Mei Zheng, Shan-Hong Tang, Hai-Qiong Wang, Shu-Lan Luo, Yong Zhang, Dong Mu, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Ning Lin, Department of Clinical Nutrition, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Jia-Yi Yang, School of Medical Imaging, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
Author contributions: Zheng SM designed the report; Mu D, Zhang Y, Tang SH, and Luo SL collected the patient’s clinical data; Wang HQ provided and analyzed the microscopy images; Yang JY and Wang HQ analyzed the ultrasound and CT images; Zheng SM and Lin N wrote the paper; and all authors have read and approved the final version to be published.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Mei Zheng, MD, Doctor, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. zhengsm@163.com
Received: July 10, 2021
Peer-review started: July 10, 2021
First decision: July 26, 2021
Revised: August 8, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 26, 2021
Processing time: 103 Days and 5.3 Hours
Abstract
BACKGROUND

While tuberculosis (TB) itself is a common disease, isolated TB of the liver is a rare entity. Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma. In contrast, isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice, with only a few sporadic cases and short series available in the current literature. Vascular complications, such as portal vein thrombosis (PVT), have rarely been reported previously.

CASE SUMMARY

A 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg. He had a 10-year hepatitis B virus (HBV) infection in his medical history. Contrast-enhanced computed tomography (CECT) confirmed hepatosplenomegaly, with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein. A liver biopsy showed epithelioid granulomas with a background of caseating necrosis. Ziehl-Nelson staining showed acid-fast bacilli within the granulomas. The patient was diagnosed with isolated hepatic TB with PVT. Anti-TB therapy (ATT), including isoniazid, rifapentine, ethambutol, and pyrazinamide, was administered. Along with ATT, the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant. He remained asymptomatic, and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.

CONCLUSION

Upon diagnosis of hepatic TB associated with PVT and HBV coinfection, ATT and anticoagulants should be initiated to prevent subsequent portal hypertension. Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.

Keywords: Hepatic tuberculosis; Portal vein thrombosis; Hepatitis B virus; Case report

Core Tip: Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma. In contrast, isolated hepatic tuberculosis (TB) spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice. Vascular complications, such as portal vein thrombosis, have rarely been reported previously. Patients with hepatitis B virus (HBV) and TB coinfection needing anti-TB therapy may have more risks for hepatic injury. We hereby describe a case with an unusual appearance of local hepatic TB associated with portal vein thrombosis and HBV coinfection who was successfully treated with anti-TB therapy, anti-coagulants, and antiviral treatment against HBV.