Systemic miliary tuberculosis after hepatocellular carcinoma resection: a case report of MDT discussion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIAO Mengjia ,  LIU Zuojin

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding?author：

LIU Zuojin, Email: 300376@hospital.cqmu.edu.cn

Keywords：

hepatocellular carcinoma; miliary tuberculosis; immune checkpoint inhibitor; multidisciplinary team

DOI：

10.7507/1007-9424.202606030

Video：

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Objective Exploring the diagnosis and treatment experience of a patient with systemic miliary tuberculosis after hepatocellular carcinoma resection under the multidisciplinary team (MDT) model. Methods The clinical data of one patient who developed systemic miliary tuberculosis during immune-targeted therapy after hepatocellular carcinoma resection, admitted to The Second Affiliated Hospital of Chongqing Medical University, were retrospectively analyzed. Results The patient was admitted with the complaint of “one-year history after surgery for hepatic malignant tumor, accompanied by newly-detected multiple systemic space-occupying lesions for one week”. The patient received transcatheter arterial chemoembolization and immune-targeted therapy previously. Following conversion therapy, the patient underwent right hemihepatectomy, cholecystectomy, omental lesion resection, gastric repair, inferior vena cava thrombectomy and intraperitoneal perfusion therapy. Immune-targeted therapy was performed after operation. Imaging studies demonstrated multiple occupying lesions. Laboratory studies showed tumor markers were at normal level. Sputum smear for acid-fast bacilli and T-cell spot test for tuberculosis were positive. After MDT discussion, systemic miliary tuberculosis was confirmed and extensive tumor metastasis was excluded. Individualized comprehensive therapy which based on anti-tuberculosis was initiated. After standardized treatment, the patient had symptomatic relief and nutriture improvement, imaging showed lesion absorption, and the patient was discharged in stable condition. Conclusion For hepatocellular carcinoma patients receiving immune-targeted therapy, when tumor metastasis is excluded, atypical systemic miliary tuberculosis should also be noticed. MDT model is critical for accurate diagnosis and treatment scheme making.

Citation： LIAO Mengjia, LIU Zuojin. Systemic miliary tuberculosis after hepatocellular carcinoma resection: a case report of MDT discussion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(9): 1197-1203. doi: 10.7507/1007-9424.202606030 Copy

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3.	陳錦濱, 張耀軍, 陳敏山. 肝癌多學科診療現狀與發展方向 [J]. 腫瘤防治研究, 2025, 52(6): 436-441.
4.	Brown ZJ, Tsilimigras DI, Ruff SM, et al. Management of hepatocellular carcinoma: a review [J]. JAMA Surg, 2023, 158(4): 410-420.
5.	Barber DL, Sakai S, Kudchadkar RR, et al. Tuberculosis following PD-1 blockade for cancer immunotherapy [J/OL]. Sci Transl Med, 2019, 11(475): eaat2702. doi: 10.1126/scitranslmed.aat2702.
6.	Ganesan P, Kulik LM. Hepatocellular carcinoma: new developments [J]. Clin Liver Dis, 2022, 27(1): 85-102.
7.	Bae S, Kim Y, Kim M, et al. Risk of tuberculosis in patients with cancer treated with immune checkpoint inhibitors: a nationwide observational study [J/OL]. J Immunother Cancer, 2021, 9(9): e002960. doi: 10.1136/jitc-2021-002960.
8.	Langan EA, Graetz V, Allerheiligen J, et al. Immune checkpoint inhibitors and tuberculosis: an old disease in a new context [J/OL]. Lancet Oncol, 2020, 21(1): e55-e65. doi: 10.1016/s1470-2045(19)30674-6.
9.	Khan Z, Jugnarain D, Mahamud B, et al. Systemic manifestation of miliary tuberculosis in patient with advanced diabetic retinopathy presenting with electrolyte imbalance, seizures, and adrenal insufficiency [J/OL]. Cureus, 2022, 14(1): e21047. doi: 10.7759/cureus.21047.
10.	Constantin A. Pulmonary nontuberculous mycobacterial disease in a tuberculosis-endemic setting: two cases illustrating diagnostic pitfalls [J/OL]. Reports (MDPI), 2026, 9(3): 265. doi: 10.3390/reports9030265.
11.	Suliman AM, Bek SA, Elkhatim MS, et al. Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer: case report and literature review [J]. Cancer Immunol Immunother, 2021, 70(4): 935-944.
12.	Basta YL, Bolle S, Fockens P, et al. The value of multidisciplinary team meetings for patients with gastrointestinal malignancies: a systematic review [J]. Ann Surg Oncol, 2017, 24(9): 2669-2678.
13.	Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature [J]. Cancer Treat Rev, 2016, 42: 56-72.
14.	深圳市第三人民醫院(國家感染性疾病臨床醫學研究中心) , 中國防癆協會結核病與糖尿病專業分會 , 中國防癆協會多學科診療專業分會 , 等. 結核病共病治療中利福霉素類藥物合理應用專家共識 [J]. 結核與肺部疾病雜志, 2025, 6 (6): 634-658.
15.	Park JH, Choe J, Bae M, et al. Clinical characteristics and radiologic features of immunocompromised patients with pauci-bacillary pulmonary tuberculosis receiving delayed diagnosis and treatment [J/OL]. Open Forum Infect Dis, 2019, 6(2): ofz002. doi: 10.1093/ofid/ofz002.
16.	中華醫學會放射學分會傳染病放射學專業委員會. 肺結核影像學及分級診斷專家共識 [J]. 新發傳染病電子雜志, 2018, 3 (2): 118-127.
17.	路希維, 賴曉宇, 曾劍鋒, 等. 肺結核與肺癌共病診療專家共識 [J]. 結核與肺部疾病雜志, 2025, 6(5): 495-515.
18.	Merhi HJ, Chamseddine MW, Mhaidly AI, et al. Metastatic lung adenocarcinoma mimicking miliary tuberculosis: a case report [J/OL]. Cureus, 2025, 17(7): e88494. doi: 10.7759/cureus.88178.
19.	Yao F, Zhang R, Lin Q, et al. Plasma immune profiling combined with machine learning contributes to diagnosis and prognosis of active pulmonary tuberculosis [J/OL]. Emerg Microbes Infect, 2024, 13(1): 2370399. doi: 10.1080/22221751.2024.2370399.
20.	方雪娥, 毛燕君. 肺結核患者營養管理護理實踐專家共識 [J]. 中國防癆雜志, 2024, 46(5): 495-501.
21.	Luo M, Zou X, Zeng Q, et al. Monocyte at diagnosis as a prognosis biomarker in tuberculosis patients with anemia [J/OL]. Front Med (Lausanne), 2023, 10: 1141949. doi: 10.3389/fmed.2023.1141949.
22.	楊敏, 王玉忠. 免疫檢查點抑制劑的作用機制及常見不良反應的研究進展 [J]. 中國臨床實用醫學, 2022, 13(4): 62-65.
23.	Park Y, Min J, Lim JU, et al. Increased risk of tuberculosis disease in lung cancer patients undergoing immune checkpoint inhibitor therapy: a retrospective multicenter study [J]. Respiration, 2025, 104(11): 847-857.
24.	Zhan M, Zhou L, Liu R, et al. Tuberculosis infection following administration of immune checkpoint inhibitors: a real world observational study [J/OL]. Front Pharmacol, 2025, 16: 1703831. doi: 10.3389/fphar.2025.1703831.
25.	Li B, Yan C, Zhu J, et al. Anti-PD-1/PD-L1 blockade immunotherapy employed in treating hepatitis B virus infection-related advanced hepatocellular carcinoma: a literature review [J/OL]. Front Immunol, 2020, 11: 1037. doi: 10.3389/fimmu.2020.01037.
26.	Liu Q, Que S, Qiu Y, et al. Host immune response to mycobacterium tuberculosis infection: implications for vaccine development [J]. J Inflamm Res, 2025, 18: 8429-8445.
27.	Yang Z, Guan R, Fu Y, et al. Risk of hepatitis B virus reactivation and its effect on survival in advanced hepatocellular carcinoma patients treated with hepatic arterial infusion chemotherapy and lenvatinib plus programmed death receptor-1 inhibitors [J/OL]. Front Cell Infect Microbiol, 2024, 14: 1336619. doi: 10.3389/fcimb.2024.1336619.
28.	Carwile ME, Hochberg NS, Sinha P. Undernutrition is feeding the tuberculosis pandemic: a perspective [J/OL]. J Clin Tuberc Other Mycobact Dis, 2022, 27: 100311. doi: 10.1016/j.jctube.2022.100311.
29.	Liao KM, Shu CC, Liang FW, et al. Risk factors for pulmonary tuberculosis in patients with lung cancer: a retrospective cohort study [J]. J Cancer, 2023, 14(4): 657-664.
30.	Zhang H, Guan W, Zhou J. Advances in the diagnosis of latent tuberculosis infection [J]. Infect Drug Resist, 2025, 18: 483-493.
31.	Wang H, Gao L, Cai X, et al. Simultaneous anti-tuberculosis and anti-tumor treatment with immune checkpoint inhibitors for co-existent pulmonary tuberculosis and advanced lung cancer [J]. Infect Drug Resist, 2025, 18: 107-112.
32.	Xu X, Wang M, Xu J, et al. Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis [J/OL]. Front Immunol, 2023, 14: 1322233. doi: 10.3389/fimmu.2023.1322233.
33.	崔迎慧, 陳國強, 程純, 等. 基于醫院全局管理的臨床研究型MDT模式實施與體會 [J]. 中國醫院管理, 2020, 40(2): 53-55.

1. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma [J]. Hepatology, Hepatology, 2020, 73 Suppl 1: 4-13.
2. Llovet JM, Castet F, Heikenwalder M, et al. Immunotherapies for hepatocellular carcinoma [J]. Nat Rev Clin Oncol, 2021, 19(3): 151-172.
3. 陳錦濱, 張耀軍, 陳敏山. 肝癌多學科診療現狀與發展方向 [J]. 腫瘤防治研究, 2025, 52(6): 436-441.
4. Brown ZJ, Tsilimigras DI, Ruff SM, et al. Management of hepatocellular carcinoma: a review [J]. JAMA Surg, 2023, 158(4): 410-420.
5. Barber DL, Sakai S, Kudchadkar RR, et al. Tuberculosis following PD-1 blockade for cancer immunotherapy [J/OL]. Sci Transl Med, 2019, 11(475): eaat2702. doi: 10.1126/scitranslmed.aat2702.
6. Ganesan P, Kulik LM. Hepatocellular carcinoma: new developments [J]. Clin Liver Dis, 2022, 27(1): 85-102.
7. Bae S, Kim Y, Kim M, et al. Risk of tuberculosis in patients with cancer treated with immune checkpoint inhibitors: a nationwide observational study [J/OL]. J Immunother Cancer, 2021, 9(9): e002960. doi: 10.1136/jitc-2021-002960.
8. Langan EA, Graetz V, Allerheiligen J, et al. Immune checkpoint inhibitors and tuberculosis: an old disease in a new context [J/OL]. Lancet Oncol, 2020, 21(1): e55-e65. doi: 10.1016/s1470-2045(19)30674-6.
9. Khan Z, Jugnarain D, Mahamud B, et al. Systemic manifestation of miliary tuberculosis in patient with advanced diabetic retinopathy presenting with electrolyte imbalance, seizures, and adrenal insufficiency [J/OL]. Cureus, 2022, 14(1): e21047. doi: 10.7759/cureus.21047.
10. Constantin A. Pulmonary nontuberculous mycobacterial disease in a tuberculosis-endemic setting: two cases illustrating diagnostic pitfalls [J/OL]. Reports (MDPI), 2026, 9(3): 265. doi: 10.3390/reports9030265.
11. Suliman AM, Bek SA, Elkhatim MS, et al. Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer: case report and literature review [J]. Cancer Immunol Immunother, 2021, 70(4): 935-944.
12. Basta YL, Bolle S, Fockens P, et al. The value of multidisciplinary team meetings for patients with gastrointestinal malignancies: a systematic review [J]. Ann Surg Oncol, 2017, 24(9): 2669-2678.
13. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature [J]. Cancer Treat Rev, 2016, 42: 56-72.
14. 深圳市第三人民醫院(國家感染性疾病臨床醫學研究中心) , 中國防癆協會結核病與糖尿病專業分會 , 中國防癆協會多學科診療專業分會 , 等. 結核病共病治療中利福霉素類藥物合理應用專家共識 [J]. 結核與肺部疾病雜志, 2025, 6 (6): 634-658.
15. Park JH, Choe J, Bae M, et al. Clinical characteristics and radiologic features of immunocompromised patients with pauci-bacillary pulmonary tuberculosis receiving delayed diagnosis and treatment [J/OL]. Open Forum Infect Dis, 2019, 6(2): ofz002. doi: 10.1093/ofid/ofz002.
16. 中華醫學會放射學分會傳染病放射學專業委員會. 肺結核影像學及分級診斷專家共識 [J]. 新發傳染病電子雜志, 2018, 3 (2): 118-127.
17. 路希維, 賴曉宇, 曾劍鋒, 等. 肺結核與肺癌共病診療專家共識 [J]. 結核與肺部疾病雜志, 2025, 6(5): 495-515.
18. Merhi HJ, Chamseddine MW, Mhaidly AI, et al. Metastatic lung adenocarcinoma mimicking miliary tuberculosis: a case report [J/OL]. Cureus, 2025, 17(7): e88494. doi: 10.7759/cureus.88178.
19. Yao F, Zhang R, Lin Q, et al. Plasma immune profiling combined with machine learning contributes to diagnosis and prognosis of active pulmonary tuberculosis [J/OL]. Emerg Microbes Infect, 2024, 13(1): 2370399. doi: 10.1080/22221751.2024.2370399.
20. 方雪娥, 毛燕君. 肺結核患者營養管理護理實踐專家共識 [J]. 中國防癆雜志, 2024, 46(5): 495-501.
21. Luo M, Zou X, Zeng Q, et al. Monocyte at diagnosis as a prognosis biomarker in tuberculosis patients with anemia [J/OL]. Front Med (Lausanne), 2023, 10: 1141949. doi: 10.3389/fmed.2023.1141949.
22. 楊敏, 王玉忠. 免疫檢查點抑制劑的作用機制及常見不良反應的研究進展 [J]. 中國臨床實用醫學, 2022, 13(4): 62-65.
23. Park Y, Min J, Lim JU, et al. Increased risk of tuberculosis disease in lung cancer patients undergoing immune checkpoint inhibitor therapy: a retrospective multicenter study [J]. Respiration, 2025, 104(11): 847-857.
24. Zhan M, Zhou L, Liu R, et al. Tuberculosis infection following administration of immune checkpoint inhibitors: a real world observational study [J/OL]. Front Pharmacol, 2025, 16: 1703831. doi: 10.3389/fphar.2025.1703831.
25. Li B, Yan C, Zhu J, et al. Anti-PD-1/PD-L1 blockade immunotherapy employed in treating hepatitis B virus infection-related advanced hepatocellular carcinoma: a literature review [J/OL]. Front Immunol, 2020, 11: 1037. doi: 10.3389/fimmu.2020.01037.
26. Liu Q, Que S, Qiu Y, et al. Host immune response to mycobacterium tuberculosis infection: implications for vaccine development [J]. J Inflamm Res, 2025, 18: 8429-8445.
27. Yang Z, Guan R, Fu Y, et al. Risk of hepatitis B virus reactivation and its effect on survival in advanced hepatocellular carcinoma patients treated with hepatic arterial infusion chemotherapy and lenvatinib plus programmed death receptor-1 inhibitors [J/OL]. Front Cell Infect Microbiol, 2024, 14: 1336619. doi: 10.3389/fcimb.2024.1336619.
28. Carwile ME, Hochberg NS, Sinha P. Undernutrition is feeding the tuberculosis pandemic: a perspective [J/OL]. J Clin Tuberc Other Mycobact Dis, 2022, 27: 100311. doi: 10.1016/j.jctube.2022.100311.
29. Liao KM, Shu CC, Liang FW, et al. Risk factors for pulmonary tuberculosis in patients with lung cancer: a retrospective cohort study [J]. J Cancer, 2023, 14(4): 657-664.
30. Zhang H, Guan W, Zhou J. Advances in the diagnosis of latent tuberculosis infection [J]. Infect Drug Resist, 2025, 18: 483-493.
31. Wang H, Gao L, Cai X, et al. Simultaneous anti-tuberculosis and anti-tumor treatment with immune checkpoint inhibitors for co-existent pulmonary tuberculosis and advanced lung cancer [J]. Infect Drug Resist, 2025, 18: 107-112.
32. Xu X, Wang M, Xu J, et al. Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis [J/OL]. Front Immunol, 2023, 14: 1322233. doi: 10.3389/fimmu.2023.1322233.
33. 崔迎慧, 陳國強, 程純, 等. 基于醫院全局管理的臨床研究型MDT模式實施與體會 [J]. 中國醫院管理, 2020, 40(2): 53-55.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Systemic miliary tuberculosis after hepatocellular carcinoma resection: a case report of MDT discussion

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