In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S1311-S1311
Kurzfassung:
This case underlines the role tuberculosis has in non-pulmonary settings. Elevated liver enzymes in any setting of tuberculosis should raise concern for TB hepatitis until proven otherwise. CASE DESCRIPTION/METHODS: A 48 year old man a with PMH of Crohn’s colitis s/p right hemicolectomy, latent tuberculosis (TB) and asthma presented for elevated liver enzymes on routine testing. He denied abdominal pain, jaundice, acholic stools or dark urine. He was taking Adalimumab, Isoniazid and Pyridoxine but ran out of medications. He emigrated from Mongolia a few years ago and endorsed heavy alcohol use (bottle of liquor 2-3 times per week) and daily herb use. His exam was notable for fever to 102.9 F, tachypnea 25 breaths/min with hypoxia SpO2 8o% and mild hepatomegaly. Labs were notable for AST 92 IU/L, ALT 157 IU/L, total bilirubin 0.9 mg/dL, ALP 476 IU/L, protein 6.5 g/dL, albumin 3.0 g/dL, INR 1.1. Viral hepatitis panel was negative and interferon gamma release assay was positive for TB. MRCP revealed an enlarged liver but otherwise normal biliary tree and gallbladder. CXR and CT chest showed innumerable pulmonary nodules and lymphadenopathy concerning for pulmonary TB, which was confirmed on bronchoscopy. Liver enzymes continued to stay elevated, so a liver biopsy obtained showed cholestatic hepatitis with no granulomas. PCR testing was added on which was positive for M. Tuberculosis DNA, consistent with TB hepatitis. The patient was started on anti-tubercolosis therapy with improvement in liver enzymes. DISCUSSION: Elevated liver enzyme testing in the setting any manifestation of tuberculosis should raise concern for TB hepatitis. The presentation is highly variable from an acute to chronic process, and the most common lab abnormality is ALP elevation. Biopsy findings with caseating granulomas is only 68% sensitive while PCR testing is 85% sensitive. Despite the multiple risk factors for acute hepatitis and nonspecific biopsy findings, if the suspicion for TB hepatitis is still high, PCR testing can be added.
Materialart:
Online-Ressource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/01.ajg.0000598944.15587.9e
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2019
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