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Hepatic tuberculosis: Comparison of miliary and local form

Leber-Tuberkulose: Vergleich der miliaren und lokalen Formen

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The clinical and pathological features of 22 patients, 11 males and 11 females 17–70 years of age (48.0±16.0 years), with hepatic tuberculosis were reviewed. Five patients had no evidence of extrahepatic tuberculosis (local form), and 17 had the miliary form. The clinical features of the miliary and local forms were similar with pyrexia, abdominal pain, hepatomegaly and body weight loss as the main manifestations. The biochemical findings were also quite similar in reversed albumin and globulin (A/G) ratio (2.9/3.5 vs. 3.2/3.4 g/dl) and disproportionate elevation of alkaline phosphatase (ALP) in comparison with bilirubin values but lower levels of alanine aminotransferase (ALT) (40.4±51.0 vs. 170.8±209.4 U/l; p<0.05) and ALP (208.5±138.9 vs. 389.5±271.1 U/l; p<0.05) in the miliary form. Patients with the local form had higher albumin (3.2±0.8 vs. 2.9±0.7 g/dl), aspartate aminotransferase (AST) (160.4±221.7 vs. 65.9±69.7 U/l), and gamma glutamyl-transpeptidase (γGT) (217.0±144.0 vs. 136.0±92.1 U/l), although the differences were not significant. The histopathological features of the miliary form were also similar to the local form with granuloma, caseation, acid-fast bacilli, fatty change and portal fibrosis as the main findings. The local form revealed more severe signs of hepatocytic damage while the miliary form was more wasting. The results suggest that the miliary and local forms of hepatic tuberculosis had quite similar clinical presentations and pathological features. The biochemical tests suggesting hepatic tuberculosis were reversed A/G ratio and disproportionate elevation of ALP.


Bei 22 Patienten mit Lebertuberkulose, 11 Männer und 11 Frauen im Alter von 17–70 Jahren (48,0±16,0 Jahre), wurden die klinischen und pathologischen Befunde ausgewertet. Bei fünf Patienten bestand kein Anhalt für eine extrahepatische Tuberkulose (lokale Form) und bei 17 bestand eine miliare Form. Die klinischen Erscheinungen der miliaren und lokalen Form waren ähnlich mit den Hauptsymptomen Fieber, Bauchschmerzen, Hepatomegalie und Gewichtsverlust. Auch in den biochemischen Befunden bestanden Ähnlichkeiten mit umgekehrter Relation von Albumin und Globulin (A/G) (2,9/3,5 beziehungsweise 3,2/3,4 g/dl) und eine im Vergleich zu den Bilirubinwerten dysproportionale Erhähung der alkalischen Phosphatase (ALP) bei niedrigerem Alaninaminotransferase (ALT)-Spiegel (40,4±51,0 gegenüber 170,8±209,4 E/l; p<0,05) und ALP (208,5±138,9 gegenüber 389,5±271,1 E/l; p<0,05) bei der miliaren Form. Patienten mit der lokalen Form hatten höhere Werte von Albumin (3,2±0,8 gegenüber 2,9±0,7 g/dl), Aspartataminotransferase (AST) (160,4±221,7 gegenüber 65,9±69,7 E/l) und Gamma-Glutamyl-transpeptidase (γGT) (217,0±144,0 gegenüber 136,0±92,1 E/l), doch waren die Unterschiede nicht signifikant. Die histopathologischen Befunde der miliaren und lokalen Form waren ebenfalls ähnlich mit den Hauptbefunden Granulombildung, Verkäsung und Nachweis säurefester Stäbchen, Verfettung und portale Fibrose. Bei der lokalen Form waren stärkere Zeichen der hepatozellulären Schädigung festzustellen, die miliare Form war mit stärkerer Gewichtsabnahme verbunden. Die Ergebnisse der Untersuchung lassen schließen, daß die miliare und lokale Form der Lebertuberkulose mit ähnlichen klinischen und pathologischen Befunden einhergehen. Biochemische Parameter, die auf eine Lebertuberkulose schließen lassen, waren umgekehrter A/G Quotient und dysproportionale Erhöhung der ALP.

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Chien, R.N., Liaw, Y.F. & Lin, P.Y. Hepatic tuberculosis: Comparison of miliary and local form. Infection 23, 5–8 (1995).

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