# Isolated nodular hepatic tuberculosis in an immunocompetent patient following dexamethasone treatment for COVID-19

## TL;DR

A healthy man developed rare liver tuberculosis after receiving high-dose dexamethasone for COVID-19, highlighting the need for careful diagnosis to avoid unnecessary surgery.

## Contribution

Reports a rare case of isolated hepatic tuberculosis in an immunocompetent patient following dexamethasone treatment for COVID-19.

## Key findings

- Isolated nodular hepatic tuberculosis can occur in immunocompetent individuals after high-dose dexamethasone.
- Preoperative PCR and histopathology are crucial for accurate diagnosis and avoiding unnecessary surgery.
- Dexamethasone-induced immunosuppression may increase the risk of tuberculosis reactivation.

## Abstract

Hepatic tuberculosis is a rare extrapulmonary manifestation of pulmonary or miliary tuberculosis, typically seen in immunocompromised individuals. Isolated nodular hepatic tuberculosis is exceptionally uncommon in immunocompetent individuals and often mimics other hepatic lesions such as hepatocellular carcinoma. We present a 35-year-old male who developed isolated nodular hepatic tuberculosis following high-dose dexamethasone treatment for COVID-19. Imaging and fine-needle aspiration cytology suggested hepatocellular carcinoma, prompting surgical hepatic segmentectomy. Postoperative histopathological analysis confirmed the diagnosis of isolated nodular hepatic tuberculosis. This case highlights the potential risk of hepatic tuberculosis during temporary immunosuppression caused by high-dose dexamethasone treatment for COVID-19. Our case also emphasizes the importance of utilizing preoperative PCR and histopathological examination in diagnosing hepatic tuberculosis, helping to prevent unnecessary surgical interventions.