"Primary" miliary tuberculosis of the liver presenting as acute cholecystitis
Garber, H.I.; Mason, G.R.; Bouchelle, W.H.
Maryland State Medical Journal 30(2): 73-74
1981
ISSN/ISBN: 0025-4363 PMID: 7230909 Document Number: 4895
Pericapsular inflammation, secondary to the Tuberculous process, produced the findings of pain, spasm and tenderness at the right upper quadrant in this patient. The perihepatitis and symptoms produced are similar to those found in the setting of pericapsular gonococcal infections, Fitz-Hugh-Curtis syndrome. This disease, too, may be difficult to distinguish from primary gallbladder disease. This clinical case is presented both because of the rarity of "primary" miliary Tuberculosis of the liver, as well as the uniqueness of this patient's mode of presentation and liver pathology. The clinical aspects of the disease are diverse and variable. This makes it a great imitator and often missed clinical diagnosis. Although hepatic granulomata are found in all forms of Tuberculosis, the great majority of patients do not present with the clinical features of 'primary" miliary Tuberculosis of the liver. Involvement of Glisson's capsule is unusual. Caseation and acid-fast bacilli are rarely, if ever, demonstrated or cultured.
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