P1078 - A Rare Case of Hepatic Tuberculosis in an Immunocompetent Patient

Ramnik Gill, MD, MS¹, Ranbir Singh, MD², Dean Rizzi, MD³, Irvin Grosman, MD^3
1New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; ²NYP Brooklyn Methodist Hospital, Brooklyn, NY; ³New York Presbyterian Brooklyn Methodist, Brooklyn, NY

Introduction: Abdominal Tuberculosis comprises around 5% of all TB cases worldwide and includes involvement of the GI tract, peritoneum, lymph nodes and solid organs. Risk factors include cirrhosis, HIV, diabetes, malignancy and chronic corticosteroid use. In the setting of active or miliary TB, abdominal involvement may develop via hematogenously or lymphatically. Diagnosis of abdominal TB may be established by presence of M. tuberculosis in peritoneal fluids, a biopsy specimen of the involved site or via mycobacterial culture or NAAT testing.

Case Description/Methods: We present a case of a 26 yo male born in Guatemala with a history of polysubstance abuse. He presented with a 3 month history of progressive dyspnea, hemoptysis, night sweats, and weight loss. On exam, he was cachectic in appearance with decreased breath sounds and poor inspiratory effort. His LFTs on admission were noted to be elevated with AST/ALT 133/135 respectively. Alk Phos was also elevated to 271 [1]. CT AP on admission noted to have mild hepatomegaly with mildly enlarged retroperitoneal lymph nodes [2]. Despite TB vaccination as a child, he was found to have NAAT positive TB. He subsequently started RIPE therapy with a significant increase in LFTs also seen in Table 1. His hospital course was complicated by non-immune mediated thrombocytopenia due to initiation of RIPE therapy further complicated by development of intraparenchymal and subarachnoid hemorrhage.

Discussion: Although the incidence of tuberculosis is declining over the years with close to 10.6 million cases in 2021, abdominal tuberculosis is only seen in only around 5% of the infected population. Of that 5%, the immunocompromised population are more likely to have disseminated spread. Elevated LFTs may reflect the site of disease; involvement of the liver parenchyma may be reflected by elevated transaminases, while involvement of the porta or biliary ducts may be reflected by elevated Alk Phos and GGT. This case also shows how patients can develop this condition despite obtaining the BCG vaccination. It seems unlikely that the initiation of RIPE therapy led to the increase in liver enzymes to develop a drug induced liver injury. This patient remained on RIPE therapy while his AST/ALT was acutely elevated and continued to improve, suggesting that this treatment was possibly therapeutic for his liver. Our case describes the course of a vaccinated, immunocompetent, young male who presented with miliary tuberculosis infiltrating the liver, leading to decompensation.




Disclosures:


Ramnik Gill, MD, MS¹, Ranbir Singh, MD², Dean Rizzi, MD³, Irvin Grosman, MD³. P1078 - A Rare Case of Hepatic Tuberculosis in an Immunocompetent Patient, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.