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To the Editor:—
In an article which appeared in The Journal August 6, Herrell and Simpson report what they consider to be a case of solitary tuberculoma of the liver with an exceedingly rare "pathologic lesion." It is highly questionable whether the authors are justified in ascribing the cause of the condition to the tubercle bacillus on the weak evidence they present. The clinical course and laboratory data are not typical of tuberculosis, no mention is made of tests with tuberculin, and no evidence of tuberculosis elsewhere was found. Under these circumstances one cannot make a diagnosis of tuberculosis simply because of the presence of small granulomas and giant cells in the lesion. Many other conditions may give rise to similar granulomatous changes in the liver, among which may be mentioned chronic low grade infection with a mixture of bacteria, actinomycosis or other fungous infections, glanders, tularemia and undulant fever.
Reimann HA. SOLITARY TUBERCULOMA OF THE LIVER. JAMA. 1938;111(12):1123. doi:10.1001/jama.1938.02790380065023