Ileocaecal TB with multiple hepatic granuloma mimicking malignancy with metastasis to liver

Abstract

Introduction: Abdominal tuberculosis is a rare manifestation of  tuberculosis1. It can involve any part of the gastrointestinal tract but the most likely sites of infection are the peritoneum and the ileo-caecal region. We present unusual a case of Ileocaecal TB with multiple hepatic  granuloma mimicking malignancy with metastasis to liver.
Case presentation: A 38 years old male, Sudanese, had two months history of painful tender mass in the right iliac fossa that was associated with low grade fever, constipation and loss of appetite. He had no symptoms or signs related to other systems and he denied any contact with chronic cough patient. ESR 100mm/hr, normal CXR, ultrasound revealed multiple hypoechoic liver focal lesions, multiple para-aortic Lymph node and a thick wall terminal ilium. CT abdomen showed bowel segment with wall thickening and irregular lumen in the right iliac fossa, enlarge para-aortic lymph nodes and multiple hepatic focal lesions which gave the impression of caecal carcinoma with liver metastasis. OGD was reported as normal. Colonoscopy revealed an abnormal mucosa at the caecum, suspicious of carcinoma caecum. Multiple biopsies were taken.  Histopathology revealed epithelioid granulomas with Langhans giant cells as well as areas of mild cryptitis, could be either tuberculosis or Crohns disease, Ultrasound guided liver biopsy from the focal lesions revealed
epithelioid cells and poorly formed granulomas with areas of caseation and fibrosis suggestive of tuberculosis. PCR for aspirate from liver focal lesion biopsy was positive for tuberculosis. The patient was treated with  antituberculous chemotherapy. Complete cure was obtained during follow
up.

Keywords: Abdominal tuberculosis, Ileocaecal tuberculosis hepatic granuloma.