Liver Paradoxical Reaction Presenting as a Solitary Hepatic Mass during Antituberculosis Therapy.
Yohei Takada, Takashi Inao, Ayumi Akamatsu et al.
✦ AI-curated · Sources linked
Case in brief
A woman in her late 20s receiving antituberculosis therapy for pulmonary tuberculosis developed a solitary hepatic mass. Contrast-enhanced ultrasonography could not distinguish inflammation from malignancy. Biopsy showed epithelioid cell granulomas without caseous necrosis; smear, culture, and polymerase chain reaction were negative. Antituberculosis therapy was continued unchanged, and the lesion regressed within 7 months, supporting a diagnosis of hepatic paradoxical reaction.
What made this case unusual
The paradoxical reaction presented as a solitary hepatic mass with imaging that could not distinguish inflammation from malignancy, while biopsy showed granulomas and microbiological tests were negative.
Diagnostic / clinical pearl
A new hepatic mass during antituberculosis therapy can reflect a paradoxical reaction even when microbiological tests are negative; interpret imaging and biopsy findings in the treatment context.
Why it matters
Recognizing this possibility may help avoid unnecessary changes to the antituberculosis regimen or invasive procedures such as surgical resection.