An Unusual Detected Cause of Abnormal Liver Enzymes in an Aircrew Member Periodical Visit: Case Report

Background: Hepatic tuberculosis (TB) is a rare entity, poorly described in the literature. It presents with nonspecific clinical manifestation and imaging findings mimicking other liver disease making diagnosis challenge. We report a case of isolated hepatic tuberculosis in asymptomatic cabin crew member diagnosed accidentally by investigating a liver chemistry test disorder.

Case Report: A 28 year-old Moroccan cabin crew attendant came to the aeromedical expertise center to perform her periodical medical assessment. She had no medical history. Physical examination was unremarkable. Liver chemistry test values were elevated. Imaging studies of the liver suggested malignant disease. Histological examination showed isolated hepatic tuberculosis.

Discussion: Isolated hepatic TB is very uncommon, lacks typical clinical manifestation and radiological features, but remains an important differential diagnosis of hepatic nodules especially in endemic areas. This observation highlights the benefit of liver chemistry test evaluation realized systematically for periodical aeromedical fitness to diagnose some pathology in asymptomatic stage avoiding complications. Hepatic TB is a cause of temporarily unfitness because it’s not compatible with flight safety conditions. Aircrew with hepatic TB will need to be assessed for both complete disease control and full resolution of any iatrogenic side effect of anti-tubercular drugs before returning to fly under some restrictions.