Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 6, Number 8, August 2015, pages 336-338

Portal Hypertension and Fever Secondary to Granulomatous Hepatitis by Tuberculosis


Figure 1.
Figure 1. Abdominal tomography showing hepatosplenomegaly with heterogeneity of hepatic parenchyma and increased portal vein caliber and splenic (asterisk).
Figure 2.
Figure 2. Splenic imaging with granulomas (rounded areas of lighter shade) at 16:19 hours. On average figure line, we observed lymphoid follicles.
Figure 3.
Figure 3. Image with diffuse hepatic granulomas with central necrosis (asterisks).


Table 1. Tests Performed in the Hospital
Laboratory tests
Tuberculin test: 0 mm
VDRL: no reagent
Viral serology for hepatitis (B and C): negative/anti-HBs +
Serology for toxoplasmosis: IgG + IgM-
Anti-HIV: no blood cultures reagent (three samples): negative
Urine culture: no bacterial growth
Beta-2-microglobulin = 4.47 μg/mL
Reticulocytes 0.93% VIT B12 1,200 pg/mL
Myelogram: slightly hypercellular. Series lymph-mono-plasma cell: lymphocytes around 4%. Plasma cells around 5%. Presence of rare macrophages presenting hemophagocytosis. Suggestive of reactive marrow.
Upper digestive endoscopy: enanthematous gastritis body and erosive den. Bilious gastric stasis
Protein electrophoresis: decreased albumin/globulin
K39: no reaction
Fe saturation index: 7%; ferritin: 432.04 ng/mL; serum iron: 19 g/dL
Antinuclear factor: not reagent
Free T4: 1.00 ng/dL
Serology for EBV IgG: 750 U/mL; IgM: 10 U/mL - no reagent serology for CMV IgG: 245.40 AU/mL; IgM: 0.18 index - not reagent
Bone marrow biopsy: absence of neoplasia. Normocellular marrow bone, myeloid hyperplasia, mild diseritropoiese.
Transesophageal echocardiography: normal, with EF 70%.
Serology for brucellosis IgG and IgM: negative
Liver Doppler: Identifies increase the speedometer of the common hepatic artery and hepatic veins. Increased gate diameter of the vein. Side of absence.
Abdominal ultrasound: hepatomegaly homogeneous and gall bladder collapsed