48-year-old male with no known comorbidities presented with complaint of abdominal pain, low-grade fever, loss of appetite, and weight since last 1 month. Ultrasound abdomen of this patient was suggestive of multiple abscesses in the left lobe of the liver, the largest measuring 4.5 x 4.8 x 3.6 cm, for which the patient had received various treatments at multiple health centers over the past month including injectable and oral antibiotics.
The patient was subsequently admitted in our hospital and thoroughly evaluated which includes a detailed history, clinical examination, biochemical, pathological, microbiological tests, and radiological imaging (Table 1). The significant laboratory and radiological finding were anemia, low albumin, high CRP, normal chest x-ray (Figure 1), and abdominal ultrasonography suggestive of identical sized abscesses in the left lobe of the liver and computed tomography of the abdomen suggestive of multiple liver abscesses in the left lobe with no other abnormalities, and then the patient underwent ultrasound guided pus aspiration and aspirate sent for fluid analysis.
The fluid cytology showed that fluid was suppurative with primarily degraded, viable polymorphs, acid fast bacilli in a necrotic backdrop. The cartridge-based nucleic acid amplification test (CBNAAT) for MTB of the aspirated sample detected MTB that was rifampicin-sensitive. Patient was then started on antitubercular treatment as per the standard National Tuberculosis Elimination Program guidelines for tuberculosis according to weight (patient's weight-52 kg) which comprises four 1st line drugs for a duration of 6 months (details in Table 2) and discharged with regular follow-up in the medicine outpatient department. During follow-up, he responded well to the treatment.