Abstract
A 76-year-old man presented with a fever of 39°C. Abdominal enhanced computed tomography showed multiple enhanced liver tumors in S4, S5/6, and S8 of uniform size, and within 3-7 cm of each other ; multiple enlarged lymph nodes were noted in the abdomen. Under a tentative diagnosis of multiple liver abscesses and inflammatory lymph node enlargement, conservative management with antibiotics was instituted Gastrointestinal fiberscopy showed gastric cancer. Under a diagnosis of gastric cancer and inflammatory hepatic granuloma, distal gastrectomy and liver biopsy were performed. Histological examination confirmed the diagnosis of epithelioid granuloma with caseous necrosis in the liver nodules and abdominal lymph nodes. Bacilli were demonstrated in the lymph nodes on Ziehl-Neelsen staining. Gaffky's scale was 0, and the tuberculin test and QFT were both positive. Thus, the final diagnosis was hepatic tuberculoma, tubercular peritonitis, and tubercular lymphadenitis. After anti-tuberculosis treatment, the hepatic tuberculoma nodules disappeared.
