Isolated Tubercular Liver Abscess: an entity rarely thought, diagnosed on cytology

INTRODUCTION: Tuberculosis is a rare cause of liver abscess in the Indian subcontinent even though the disease itself has high prevalance rates here. Isolated tubercular liver abscess presenting without any other foci of infection is a rare presentation with a documented prevalence of 0.34%. In an adult immune competent patient diagnosis can be challenging as it is likely to be confused with pyogenic and amoebic liver abscess or hepatoma. CASE HISTORY:  A 30 year old female patient presented with complaints of low grade fever, vague abdominal pain of 4 months duration, breathlessness and loss of appetite for 1 month. Past or family history was non-contributory. Ultrasonography abdomen revealed a small hypoechoic lesion in sub-hepatic region of size 49x20mm suggestive of a liver abscess. Computerized Tomographic scan images confirmed loculated irregular collections in and around left lobe of liver and Reidel’s lobe. Fine needle aspiration cytology from the lesion revealed ill formed granulomas on a necrotic background. Zeihl Neelson staining was positive for acid fast bacilli CONCLUSION:  Isolated tubercular liver abscess is a rare entity, particularly in immunocompetent individuals.Symptomatology and radiologic findings may not be contributory. Diagnosis of this entity rests on the demonstration of acid fast bacilli in material obtained. FNAC is a simple minimally invasive, cost effective procedure which helps attain the same. DOI: 10.21276/APALM.1382