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 (gamma GT) (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.