Nadia Ben Mustapha
Sami Karoui
Meriem Serghini
Lamia Kallel
Amina Mekni
Faouzi Chebbi
Samira Matri
Slim Haouet
Jalel Boubaker
Zoubeir Ben Safta
Azza Filali


Aims : The aims of our study were to determine the frequency of granulomatous hepatitis in patients with peritoneal tuberculosis, to identify factors for high risk and whether it is associated with higher frequency of antituberculous treatment side effects.
Methods: We carried out a prospective study on patients with histologically proven peritoneal tuberculosis between January 1996 and December 2005. We performed a liver biopsy in all the patients before starting the antituberculous treatment. Granulomatous hepatitis was systematically searched in all patients.
Results: The study was conducted in 52 patients, 9 men and 43 women of median age of 35,5 years. A granulomatous hepatitis was seen in 24 patients (46%). In univariate analysis the factors associated with a high risk of liver involvement were a higher level of gamma-glutamyl transpeptidase (44.5 + 36.8 IU/l vs 23.3 + 9.28 IU/l p = 0.005), a higher level of phosphatases alkalines (233.9 + 96.6 IU/l vs 189.4 + 49.9 IU/l p = 0.03) and a lower level of cholesterol (1.22 + 0.2 g/l vs 1.56 + 0.3 g/l p < 0.0001). In multivariate analysis, only a cholesterol level lower than 1,31 g/l was significantly associated with a granulomatous hepatitis (p = 0.006
OR [IC95%] : 0.10 [0.02 – 0.52]).
Conclusion: We have found a frequent liver involvement in the case of peritoneal tuberculosis (46%). Cholesterol level lower than 1,31gr/l was an independent predictor of granulomatous hepatitis in patients with peritoneal tuberculosis. We suggest, in this case, that percutaneous liver biopsy can be considered as an alternative to laparoscopy.


Granulomatous hepatitis, Peritoneal tuberculosis



  1. Raviglione MC, Snider Jr, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995; 273: 220-6.
  2. Sheer TA, Coyle WJ. Gastrointestinal tuberculosis. Curr Gastroenterol Rep 2003; 5: 273-278.
  3. Bouraoui S, Haouet S, Mekni A, Ouertani L, Bellil K, Bellil S, Daghfous A, Kchir MN. Extrapulmonary tuberculosis in Tunisia. Report of 830 cases. Experience of the Anatomic Pathology Laboratory of the Rabta Hospital. Tunis Med 2003; 81 : 529-34.
  4. Farer LS, Lowell AM, Meador MP. Extrapulmonary tuberculosis in the United States. Am J Epidemiol 1979; 109: 5-15.
  5. Aston NO. Abdominal tuberculosis. World J Surg 1997; 21: 492-9.
  6. Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998; 74: 459-6.
  7. Bedioui H, Ksantini R, Nouira K, Mekni A, Daghfous A, Chebbi F et al. Role of laparoscopic surgery in the etiologic diagnosis of exsudative ascites: a prospective study of 90 cases. Gastroenterol Clin Biol 2007; 31: 1146-1149.
  8. Hamadani A, Sekkat N, Alyoune A. La tuberculose péritonéale chez l'adulte, étude de 207 cas. Ann Gastro Hepato 1987; 23: 115-22.
  9. Beannai A, Ouazzani H, Fadli F. Aspects diagnostiques et thérapeutiques au maroc des tuberculoses péritonéales à propos de 300 cas. Ann Gastro Hepato 1988; 24: 347-54.
  10. Inadomi JM, Kapur S Kinkhabwala M, Cello JP. Gastrointest Endo Clin N Am 2001; 11: 79-91.
  11. Bergter W, Fetzer IC, Sattler B, Ramadori G. granulomatous hepatitis preceding Hodgkin's disease, Case-report and review on differential diagnosis. Pathology Oncology Research 1996; 3, 177-180.
  12. McCluggage WG, Sloan JM. Hepatic granulomas in Northern Ireland: a thirteen year review. Histopathology 1994; 25: 219- 228.
  13. Satti MB, Hussein AF, Ibrahim J, et al. Hepatic granuloma in Saudi Arabia: a clinicopathological study of 59 cases. Am J Gastroenterol 1990; 85: 669-74.
  14. Cunningham D, Mills PR, Quigley EMM, et al. Hepatic granulomas: experience over a 10 year period in the West of Scotland. Q J Med 1982; 51: 162-70.
  15. Sartin JS, Walker RC. Granulomatous hepatitis: a retrospective review of 88 cases at the Mayo Clinic. Mayo Clin Proc 1991; 66: 914-18.
  16. Gilinsky NH, Campbell JAH, Kirsch RE. The clinical spectrum of hepatic granuloma. S Afr Med J 1984; 60: 691-694.
  17. Gaya D R, Thorburn D, Oien K A, Morris A J, Stanley A J. Hepatic granulomas: a 10 year single centre experience. J Clin Pathol 2003; 56: 850-853.