Isolated Liver Tuberculoma Infiltrating Anterior Abdominal Wall And Skin

A 56-year-old woman presented with a 9-month history of intermittent fevers and pain in the right upper quadrant of the abdomen. For the last 2 months she noticed a painful swelling and skin redness in the upper abdomen. She had no respiratory symptoms. The physical examination revealed hepatomegaly and fistulizing skin changes in epigastrium with minimal purulent secretion. Laboratory tests showed elevated white-cell count (17,000 per microliter), CRP of 76mg/l and elevated liver markers (aspartate aminotransferase 122 U/L, alanine transaminase 140 U/L, total bilirubin 43 mg/dL) while prothrombin time was normal.