Isolated Tubercular Subcapsular Liver Abscess: A Rare Manifestation of Extrapulmonary Tuberculosis

Introduction: Isolated tubercular liver abscess without any other foci of infection is an extremely rare presentation of tuberculosis with a prevalence of only 0.34%. The diagnosis can be extremely challenging on account of the non specific presentation and is frequently confused with hepatoma, pyogenic liver abscess or amoebic liver abscess. Case Presentation: A 44 year old man presented with non specific complaints of low grade fever, weight loss and vague abdominal pain. Ultrasonography of the abdomen revealed a collection in the liver with few adhesions in the bowel loop. A contrast enhanced CT scan of the abdomen proved it to be a loculated subcapsular abscess of the liver. A CT guided fine needle aspiration from the collection showed suppurative material with acid fast bacilli, singly and in clumps. Except for a mild derangement of liver function tests, all other blood tests were normal. The patient was started on anti-tubercular therapy with the diagnosis of a tubercular subcapsular abscess of the liver. Conclusion: Although tubercular liver abscess is very rare, it should be included in differential diagnosis of liver abscess and undiagnosed hepatic mass lesions. Appropriate investigations should be done to establish a definitive diagnosis to initiate appropriate therapy.