A case of miliary tuberculosis presenting as massive hepatosplenomegaly and fatal hepatic failure

摘要

The clinical manifestations of miliary tuberculosis are protean and non-specific [1]. The liver is often involved in patients with military tuberculosis, but hepatic involvement is rarely accompa- nied by clinical manifestations or fatal [2,3]. We believe that the presenting symptoms in our patient, including upper abdominal pain, nausea and anorexia, were primarily due to the massive hepatosplenomegaly and hepatitis caused by tuberculosis infec- tion. A postmortem examination was not performed in this patient. It is conceivable that the hepatic failure and hepatomegaly could have been due to liver toxicity from whatever antimicrobial she was given or some home remedy. The pancytopenia in our patient could have been attributed to multiple factors, including hyper- splenism, tuberculosis involvement of the bone marrow and tuberculosis-associated hemophagocytic syndrome. Clinicians should be aware of an unusual presentations of miliary tuberculo- sis, including massive, potentially fatal, hepatic involvement, as in this case.