Fig. 2

A 39-year-old African man had renal transplant 3 months before presenting to the hospital with an unexplained high fever. His organ functions deteriorated quickly and he was admitted to the ICU with severe sepsis. He needed assisted ventilation, his renal function deteriorated quickly, and his bilirubin and liver enzymes became very high. The patient did not respond to empirical antibiotics. Abdominal CT scan showed a normal liver and spleen with increased enhancement without focal lesions. Tuberculosis was suspected because of a previous history of exposure to tuberculosis despite the negative CT findings. Liver biopsy was performed which was diagnostic of TB. a Hematoxylin and Eosin (× 4), showed a well-circumscribed granuloma (arrows) within liver tissue, without evidence of caseous necrosis or giant cells. b Ziehl-Neelsen stain ((× 40), for mycobacterium tuberculosis revealed numerous red rods or bacilli (black arrows). In addition, epithelioid macrophages (red arrow) and lymphocytes were identified (Courtesy of Navidul Haq Khan, Consultant pathologist, Tawam Hospital, Al-Ain, UAE)