Hepatobiliary tuberculosis in the developing world

Table 2 Summary of systematically reviewed clinical cases of hepatobiliary/miliary tuberculosis

Ref.	Country	Age (year)	Sex	Clinical presentation	Diagnostic modalities	Treatment	Outcome	Quality assessment
Patel et al[44], 2016	India	14	Female	Persistent, intermittent fever associated with chills, abdominal pain, anorexia for 1 mo; neurological symptoms	Ultrasound of abdomen with portosplenic doppler; CT scan of the abdomen; bacterial culture of liver abscess; TB-PCR; mycobacterium growth indicator tube culture; MRI of the brain	Dexamethaxone for meningitis; rifampicin, Isoniazid, pyrazinamide ethambutol	Neurological symptoms regressed; significant improvement	High
Sahin et al[45], 2014	Turkey			Elevated liver enzymes	Liver biopsy CT scan of the abdomen	Not specified	Not specified	Low
Diallo et al[46], 2016	Dakar, Sénégal	48	Female	Cholestatic jaundice, right upper quadrant pain, fever (38.5 °C) and weak general condition, weight loss of 15 kg in 2 mo; on physical examination there was jaundice, fever, abdomen was soft, tenderness at the RUQ with hepatomegaly	Abdominal ultrasound; thoracoabdominal CT scan; liver biopsy	Rifampicin, isoniazid, pyrazinamide ethambutol; levofloxacin (included in the triple therapy for 10 d)	Good evolution: Clinical improvement, normalization of liver function tests	High
Ozin et al[47], 2010	Turkey	43	Female	Initially complained of malaise and itching, with elevate liver enzymes and bilirubin; diagnosis: Hepatobiliary tuberculosis	Hepatobiliary tree and pancrease ultrasound; ERCP; liver biopsy	Rifampicin, isoniazid, pyrazinamide ethambutol	Liver function tests were improved	High
Jain et al[48], 2017	India	50	Male	Jaundice since 10 d associated with significant loss of weight & appetite; diagnosis: Hepatobiliary tuberculosis	Liver ultrasound; CT scan of the abdomen; MRCP; and liver hepatectomy	Rifampicin, isoniazid, pyrazinamide ethambutol	Responded well	High
Chang et al[49], 2018	Taiwan	80	Male	Smear-positive, culture confirmed pulmonary TB, fever and chills after 1 wk of treatment; abdominal pain; diagnosed with cholecystolithiasis	Abdominal ultrasound; sputum AFB	Laparoscopic cholecystectomy; rifampicin, isoniazid, pyrazinamide ethambutol	ABE were not noted	High
Chang et al[49], 2018	Taiwan	50	Male	A male patient in his 50 s with comorbid, medically controlled DM and COPD was diagnosed with pulmonary TB based on a histology report of a transbronchial lung biopsy and a mycobacterial; culture of bronchial washing sample; diagnosed with acute cholecystitis	Abdominal ultrasound; CT scan of the abdomen	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Chang et al[49], 2018	Taiwan	50	Male	Hypertension and COPD, irregular medical control, diagnosed with smear-positive, culture-confirmed pulmonary TB. Two weeks prior to the commencement of standard anti-TB treatment, he had pneumonia with respiratory failure and septic shock; multiple cholelithiasis was noted with dilated intrahepatic duct; treatment was halted	Hepatobiliary tree and pancrease ultrasound	Rifampicin, isoniazid, pyrazinamide ethambutol	Died of refractory septic shock	High
Chang et al[49], 2018	Taiwan	20	Male	Fever, chest pains, left pleural effusionImpression: Intermittent biliary obstruction due to a passing of stone	Sputum-AFB	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Yamashita et al[50], 2014	Japan	48	Female	Past history of systemic lupus erythematosus developed autoimmune hepatitis, fever; diagnosis: Miliary tuberculosis	CT scan of the abdomen; liver biopsy	Isoniazid, rifampicin, ethambutol, pyrazinamide; subsequently changed to levofloxacin, ethambutol and streptomycin	Recovered liver function improved and no inflammatory reaction	Moderate
Yamane et al[51], 2010	Japan	47	Male	Incidental finding of an abnormality in the duodenum during endoscopy; no subjective symptoms; diagnosis: Tubercular papillitis of vater	Esophagogastroduodenoscopy; colonoscopy	Rifampicin, isoniazid, pyrazinamide ethambutol	Improvement of the duodenal lesion and colonic lesion	High
Ratanarapee et al[52], 1991	Thailand	38	Male	2-mo history of painless obstructive jaundice; cachectic and deeply icteric, with a normal temperature and an impalpable liver; diagnosis: Tuberculosis of the common bile duct	Ultrasound of the hepatibiliary tree	Rifampicin, isoniazid, ethambutol	Good health	High
Tewari et al[53], 2009	Japan	70	Female	Episodes of mild upper abdominal pain and vomiting of 3 mo; mild jaundice for 2 mo that subsided on its own; diagnosis: Tubercular ampullary papillitis	Ultrasound of the abdomen; CT scan of abdomen; EGD; ERCP; excision of the ampulla, with biopsy	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Li et al[54], 2015	China	39	Female	10-d history of fatigue, anorexia, and jaundice. She had no abdominal pain or fever; diagnosis: Pelvic and Salpinx tuberculosis with secondary fulminant hepatic failure	CT scan of abdomen	Rifampicin, isoniazid, pyrazinamide ethambutol	Died as a consequence of ischemic cholangitis and pulmonary infection	High
Hickey et al[35], 1999	Ireland	50	Male	Pyrexia of unknown origin which was ongoing for 2.5 yr with multiple previous hospital admissions; diagnosis: Splenic tuberculosis	Ultrasound of the abdomen; abdominal CT scan	Rifampicin, isoniazid, pyrazinamide ethambutol	Well for over 6 yr	High
Hickey et al[35], 1999	Ireland	70	Male	6-wk history of progressive jaundice, severe pruritus, dark; urine, pale stools, and weight loss, with groin swelling	Percutaneous transhepatic cholangiography; biopsy of groin swelling	Rifampicin, isoniazid, pyrazinamide ethambutol	No recurrence for 5 yr	High
Gaspar et al[55], 2018	Portugal	35	Male	Fatigue, fever, weight loss, cough, abdominal pain, diarrhea, pruritus, hepatomegaly; diagnosis: Hepatic granuloma	CT scan of the abdomenliver biopsy	Rifampicin, isoniazid, pyrazinamide ethambutol	Discharged from the hospital	Mod
Musumba et al[56], 2013	United Kingdom	47	Male	5-d history of intermittent fever, rigors and night sweats; post cadaveric renal transplant 1 mo prior, and receives immunosuppressive therapy; diagnosis: Miliary tuberculosis	Whole body positron emission tomography/computed tomography; liver biopsy	Rifampicin, isoniazid, pyrazinamide ethambutol	Good clinical response	High
Poplin et al[57], 2020	United States	52	Male	1 mo PTC, hospitalized for culture-negative spontaneous bacterial peritonitis, liver disease was incidentally found; recurrent fever; diagnosis: Miliary TB; end-stage liver disease	Liver biopsy; CT scan of abdomen	Rifampicin, ethambutol, levofloxacin, amikacin 3 times weekly	Died due to ABE	High
Huang et al[21], 2003	Taiwan	47	Male	Epigastric pain; CT scan solitary liver nodule 13.5 cm tumor left lobe	Lobectomy, anti-TB Meds	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Huang et al[21], 2003	Taiwan	57	Male	Malaise, weight loss; CT scan; solitary liver nodule 5.0 cm tumor at the left lobe	Wedge resection, anti-tb meds	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Huang et al[21], 2003	Taiwan	63	Male	Managed for gastric cancer; CT scan; solitary liver nodule 2.0 cm at segment IV	Wedge biopsy		Expired	High
Huang et al[21], 2003	Taiwan	67	Female	Managed for gastric cancer; CT scan MULTIPLE small liver nodules at both lobes	Biopsy, refused treatment	Rifampicin, isoniazid, pyrazinamide ethambutol	Dropped out of management	High
Huang et al[21], 2003	Taiwan	71	Female	Epigastric pain with upper gastrointestinal tract bleeding; CT scan; solitary liver nodule 12.0 cm at the left lobe; nodular density at the right lower lung field on chest X-ray	Left hepatectomy; anti-tb meds	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High
Zhang et al[29], 2014	China	30	Male	Weight loss, poor appetite, body weakness, abdominal distention, chest congestion	CT scan; FNAB	Rifampicin, isoniazid, pyrazinamide ethambutol	Improved	High

TB: Tuberculosis; COPD: Chronic obstructive pulmonary disease; FNAB: Fine needle aspiration biopsy; RUQ: Right upper quadrant; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; CT: Computed tomography; MRI: Magnetic resonance imaging; PCR: Polymerase chain reaction; ABE: Acute biliary events.