Isolated hepatic tuberculoma: A case report and review of the literature

Table 3 Diagnosis and treatment process of this case

Date	Action	Outcome
January 16, 2022	Hospital admission	Admitted with a 5-day history of epigastric pain
January 16-18, 2022	Initial laboratory and imaging investigations	Elevated liver enzymes (ALT 295 U/L AST170U/L). CT/MRCP identified a 20-28 mm hypodense lesion in the caudate lobe with enlarged, rim-enhancing lymph nodes
January 20, 2022	Abdominal MRI with contrast	Confirmed irregular mixed-signal foci in the caudate lobe
January 24, 2022	EUS-FNA	Tissue samples obtained from the liver lesion and adjacent lymph nodes
January 24, 2022	Cytological examination report	Specimen showed necrotic background with lymphocytes, multinucleated giant cells, and epithelioid cells
January 26, 2022	Gene-Xpert (MTB/RIF)	Mycobacterium tuberculosis DNA detected (low levels). No rifampicin resistance detected
January 27, 2022	Antitubercular therapy initiated	Standard HRZE regimen initiated (isoniazid, rifampin, ethambutol, pyrazinamide)
January 28, 2022	Pathological and genetic	Histopathology confirmed granulomatous inflammation with necrosis. TB RT-PCR was positive
January 30, 2022	Hospital discharge	Discharged in stable condition on anti-TB medications
May 10, 2022	Outpatient follow-up visits	The treatment compliance was good, and no significant adverse reactions were reported. Ultrasound showed a 2.5 cm × 1.7 cm slightly hypoechoic area in the caudate lobe of the liver; Another 1.5 cm × 1.2 cm slightly high echo area can be seen
Monthly	Outpatient follow-up visits	Good treatment compliance with no significant adverse effects reported
November 17, 2023	Final imaging follow-up	Ultrasound confirmed complete resolution of the liver lesion, indicating clinical cure
November, 2023	Completion of anti-TB therapy	Total treatment duration: 22 months

TB: Hepatic tuberculosis; RT-PCR: Reverse transcription-polymerase chain reaction; HRZE: Isoniazid, rifampicin, pyrazinamide, and ethambutol; CT: Computed tomography; MRCP: Magnetic resonance cholangiopancreatography; MRI: Magnetic resonance imaging; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration biopsy; ALT: Alanine transaminase.