Background: Extrapulmonary tuberculosis causing liver abscesses is quite rare and only about 90 cases have been reported in world literature.
Case Report: 27 year old army soldier with Acute Lymphoblastic Leukaemia got admitted with neutropenic fever. He developed chickenpox and started on acyclovir. Amphotericin B too was commenced. Blood culture yielded Candida tropicalis. No acid fast bacilli in sputum. ECHO showed no vegetations. Patient was afebrile after 2 weeks. Amphotericin B was continued for 03 weeks. Repeat USS of the abdomen showed two focal lesions in liver. US guided aspiration of larger abscess revealed straw coloured fluid and sent for cultures. Gram stained smear of the aspirate showed pus cells but there were no organisms. No growth in bacterial culture. No fungi seen with fungal stains.. Fungal culture grew Pseudoallescheria boydii. He was afebrile for 03 weeks and clinically better. After 02 weeks he developed high fever, cough and vomiting with severe neutropenia.. Repeat USS of abdomen showed new target lesion suspecting an early abscess. Two blood cultures showed Candida tropicalis suspecting a disseminated candida infection. Patient was recommenced on amphotericin B. He developed loose stools, vomiting and abdominal distention and fever. USS of abdomen showed evidence of colitis. Patient passed away. One month later, mycobacterial culture of liver aspirate yielded Mycobacterium tuberculosis which was sensitive to all first line antit-tuberculous drugs.
Conclusion: Extrapulmonary tuberculosis should be suspected in patients who have been neutropenic for a longer period. Rapid diagnostic methods are essential to initiate anti – tuberculous therapy early.