Disseminated tuberculosis manifesting as cholestasis in a patient with AIDS: a presentation to remember

A 48-year-old man of Indian descent and chronic untreated HIV infection presented with a 3-week history of persistent fever, jaundice and a subacute 10-pound weight loss. His presentation was notable for a painless cholestatic jaundice. An extensive evaluation was pursued around cholestasis and liver disease, with a resulting unremarkable workup for viral, bacterial and tick borne infectious aetiologies. A CT scan of the abdomen fortuitously revealed incidental pleural effusions and a subsequent CT scan of the chest demonstrated miliary infiltrates, suspicious for disseminated tuberculosis (TB). The diagnosis was confirmed by GeneXpert PCR and culture of induced sputa, which were positive for Mycobacterium tuberculosis. We have highlighted this unusual presentation of disseminated TB, manifesting initially as cholestasis in a patient with AIDS.