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UTILITY OF LIVER BIOPSY IN HIV-INFECTED PATIENTS PRESENTING WITH FEBRILE ILLNESSES AND INCONCLUSIVE EVALUATION
Abstract
Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIVinfected patients presenting with febrile illnesses and inconclusive initial investigative work up.
Design: A retrospective descriptive study.
Setting: The Aga Khan University Hospital, Nairobi.
Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007.
Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260U/L and 304U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72U/L respectively.
Conclusion: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV- infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis.
Design: A retrospective descriptive study.
Setting: The Aga Khan University Hospital, Nairobi.
Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007.
Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260U/L and 304U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72U/L respectively.
Conclusion: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV- infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis.
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