Re: Hepatobiliary tuberculosis: a notorious mimic to be considered within the differential

Abstract

We read with great interest an article entitled: hepatobiliary tuberculosis: a notorious mimic to be considered within the differential diagnosis of cholangiocarcinoma by Chapman NG et al. recently published in your esteemed journal. 1 It is indeed challenging to differentiate hepatobiliary tuberculosis from cholangiocarcinoma, particularly in areas where its incidence is low. We would like to congratulate the authors for reporting such an unusual case. We have a few comments regarding the article that you may find pertinent.The authors had used antituberculous drug therapy for 9 months. 1 We would like to mention that treatment for extrapulmonary tuberculosis, including peritoneal or hepatobiliary disease, is recommended for 6 months as there is no significant difference in outcomes between the 6-and 9-month regimens. 2 The treatment regimen for extrapulmonary TB consists of four drugs (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) for the first 2 months (intensive phase) followed by a two-drug regimen (Isoniazid, Rifampicin) for the next 4 months (maintenance phase). 3 Pyridoxine is added to this regimen to prevent peripheral neuropathy, an adverse effect of isoniazid.We would like to state that adenosine deaminase (ADA) activity in ascetic fluid suspicious of tuberculosis has a sensitivity and specificity of 100% and 97%, respectively. 4 ADA is a marker of tuberculosis and can be assayed in any fluid suspicious of tuberculosis such as pulmonary fluid, bile, cerebrospinal fluid and so forth.