Atypical mycobacterial infection mimicking metastatic cholangiocarcinoma

Abstract

Mycobacterial infections are rare in developed countries. Isolated involvement of the liver and biliary tree by mycobacterial infection is extremely rare. We report a case of a 45-year-old Caucasian female presenting with obstructive jaundice with a common bile duct stricture and multiple hypodense liver lesions raising suspicion of a metastatic cholangiocarcinoma. Percutaneous core biopsies of the liver lesions however suggested granulomatous process and histology at surgical excision confirmed this finding. Atypical mycobacteria (M. abcessus) sensitive to Amikacin were cultured from the surgical specimen proving the diagnosis. With the resurgence of tubercular and atypical mycobacterial infections in the developed world, it is important not to overlook these in differential diagnosis of various malignancies.

Liver Mass Caused by Mycobacterium fortuitum: A Rare Case Diagnosed by EUS-FNA

“…Like a hepatic tuberculoma, this hepatic mass resolved with antimicrobial agents and did not require drainage. Few publications describe isolated liver involvement by an atypical mycobacterial infection, 9,10 but none are associated with M. fortuitum .…”

Liver and Bile Duct Infections

“…173,180,192 Biliary involvement mimicking cholangiocarcioma has also been reported with the atypical Mycobacterium abscessus. 193 In HIV patients initiating HAART, coinfection with TB may precipitate an inflammatory reaction to TB antigens known as the immune reconstitution inflammatory syndrome (IRIS). IRIS is characterized clinically by hepatomegaly, abdominal pain, elevated liver enzymes, jaundice, and constitutional symptoms, such as fever.…”

Hepatobiliary tuberculosis: a notorious mimic to be considered within the differential diagnosis of cholangiocarcinoma

“…4 Mycobacterium tuberculosis is not unique in this regard, as hepatobiliary infection with atypical mycobacteria such as Mycobacterium abscessus has caused similar diagnostic uncertainty. 5 In many cases, the diagnosis is only identified post-operatively.…”