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Original ArticleOpen Access
Clinical Spectrum of Hepatic Tuberculosis : Comparison between Immunocompetent and Immunocompromised Hosts
Vilaichone R 
,
Vilaichone PW ,
Tumwasorn S ,
Suwanagool P ,
Wilde H ,
Mahachai V
,
Vilaichone PW ,
Tumwasorn S ,
Suwanagool P ,
Wilde H ,
Mahachai V Background
: Hepatic tuberculosis has been reported in normal and immunocompromised
hosts. However, have found no published comparisons between these two groups of subjects with
hepatic tuberculosis have been found. The aim of this study was to compare the clinical manifestations,
biochemical tests, radiologic features and pathological findings of hepatic tuberculosis in immuno-
compromised and immunocompetent patients.
Method
: The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted
between January 1993 and October 2000 to Chulalongkom University Hospital, Thailand. There were
12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE)
male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations,
biochemical tests, radiologic features and pathological findings were compared between these 2
groups. The diagnosis of
Mycobacterium tuberculosis (M. tb)
was the combination of a demonstrated
organism in hemo-or specimen culture, histopathology (positive acid fast bacilli) and rapid identifica-
tion of
M. tb
from nested polymerase chain reaction (nPCR) assay based on amplification of the
IS 6110 insertion sequences.
Results
: The clinical features were similar in both groups with fever, weight loss and hepato-
megaly as the main manifestations. The biochemical findings were also similar but the alkaline phos-
phatase (ALP) was significantly higher in the immunocompromised group (p
<
0.001). Hepatomegaly
and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found
more commonly in the immunocompetent subjects, although the differences were not statistically
significant. Non-caseating granuloma without detection of acid fast bacilli was a common finding in
both groups. The nested PCR assay increased the sensitivity from 49 per cent to 86 per cent compared
to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was signi-
ficantly higher in immunocompetent patients (p
<
0.05) due to the extreme age and severe coexisting
diseases.
Vol. 86 Suppl 2
HEPATIC TUBERCULOSIS
S433
Conclusion : Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and
reverse A/G ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was sig-
nificantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and
specificity in the diagnosis of this disease.
Key word : Hepatic Tuberculosis, Immunocompetent, Immunocompromised
: Hepatic tuberculosis has been reported in normal and immunocompromised
hosts. However, have found no published comparisons between these two groups of subjects with
hepatic tuberculosis have been found. The aim of this study was to compare the clinical manifestations,
biochemical tests, radiologic features and pathological findings of hepatic tuberculosis in immuno-
compromised and immunocompetent patients.
Method
: The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted
between January 1993 and October 2000 to Chulalongkom University Hospital, Thailand. There were
12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE)
male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations,
biochemical tests, radiologic features and pathological findings were compared between these 2
groups. The diagnosis of
Mycobacterium tuberculosis (M. tb)
was the combination of a demonstrated
organism in hemo-or specimen culture, histopathology (positive acid fast bacilli) and rapid identifica-
tion of
M. tb
from nested polymerase chain reaction (nPCR) assay based on amplification of the
IS 6110 insertion sequences.
Results
: The clinical features were similar in both groups with fever, weight loss and hepato-
megaly as the main manifestations. The biochemical findings were also similar but the alkaline phos-
phatase (ALP) was significantly higher in the immunocompromised group (p
<
0.001). Hepatomegaly
and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found
more commonly in the immunocompetent subjects, although the differences were not statistically
significant. Non-caseating granuloma without detection of acid fast bacilli was a common finding in
both groups. The nested PCR assay increased the sensitivity from 49 per cent to 86 per cent compared
to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was signi-
ficantly higher in immunocompetent patients (p
<
0.05) due to the extreme age and severe coexisting
diseases.
Vol. 86 Suppl 2
HEPATIC TUBERCULOSIS
S433
Conclusion : Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and
reverse A/G ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was sig-
nificantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and
specificity in the diagnosis of this disease.
Key word : Hepatic Tuberculosis, Immunocompetent, Immunocompromised
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