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CORRESPONDENCE
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 317
 

Tuberculous cholecystitis


1 Department of Microbiology, Institute of Medical Sciences and SUM Hospital, S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha, India
2 Department of Radiology, Institute of Medical Sciences and SUM Hospital, S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha, India

Date of Submission29-Apr-2013
Date of Acceptance06-May-2013
Date of Web Publication25-Jul-2013

Correspondence Address:
B Swain
Department of Microbiology, Institute of Medical Sciences and SUM Hospital, S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.115672

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How to cite this article:
Swain B, Otta S, Mohapatra S. Tuberculous cholecystitis. Indian J Med Microbiol 2013;31:317

How to cite this URL:
Swain B, Otta S, Mohapatra S. Tuberculous cholecystitis. Indian J Med Microbiol [serial online] 2013 [cited 2019 Sep 17];31:317. Available from: http://www.ijmm.org/text.asp?2013/31/3/317/115672


Dear Editor,

Gall bladder tuberculosis (GT) is a very rare condition even in tuberculosis endemic areas. Imaging studies in these cases often mislead the clinician for a diagnosis of carcinoma gallbladder (GB). A 62-year-old male patient was admitted to the surgery ward with chief complaints of vomiting and weakness for 1 day. He had past history of recurrent nausea and mild pain abdomen. On examination, he was thin built and had mild tenderness in the right hypochondrium. Laboratory examination revealed neutrophilic leukocytosis, positive tuberculin test and raised erythrocyte sedimentation rate, but all other haematological, biochemical and serological tests including that for human immunodeficiency virus and tuberculosis were normal. Ultrasound and contrast-enhanced computed tomography showed a partially contracted gall bladder with oedematous wall-thickening and multiple calculi in lumen. There was a focal rent in GB wall with duodenal communication suggesting a cholecysto-duodenal fistula. On endoscopic examination, there was gastroesophageal reflux disease and features of gastric outlet obstruction. Keeping in mind carcinoma GB laparotomy was performed, which showed an irregularly distended GB and dense omental adhesion to the liver bed. There were multiple stones and purulent effusion in the GB fossa. Resected GB was sent for histopathology and pus was submitted for bacteriological examination. Ziehl Neelsen staining of this pus revealed acid fast bacilli [Figure 1], which was identified as Mycobacterium tuberculosis after culture and biochemical tests. [1] Though the first case of GT was described in 1870 by Gaucher, yet it is a rarely reported disease. [2] A large number of nonspecific symptoms, [3] variable liver function test results [4] and ambiguity in the radiological investigations [3] make the preoperative diagnosis extremely difficult. Histopathology of cholecystectomy specimen often is the only aid in diagnosis. In our case, histopathological examination revealed xanthogranulomatous cholecystitis. This can be explained by the GB perforation and biliary fistula leading to chronic inflammation. Tuberculosis may be one of the risk factors for xanthogranulomatouscholecystitis, but it needs further evaluation. Absence of tubercles in the mucosa is explained by haematogenous or lymphatic spread of tuberculosis. Demonstration of acid fast bacilli though provides confirmatory diagnosis is rarely positive. [5] On anti-tubercular therapy, the patient recovered from his symptoms. Simple staining techniques of aspirated materials should never be neglected as histopathological study may sometimes give misleading reports particularly when any secondary pathology dominates over the primary GT.
Figure 1: Acid-fast bacilli with pus cells in the Ziehl Neelsen stain of aspirated pus

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 ~ Acknowledgment Top


We are thankful to the S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha for giving permission to perform this research work.

 
 ~ References Top

1.Forbes BA, Sahm DF, Weissfeld AS, editors. Mycobacteria. Bailey and Scott's Diagnostic Microbiology. 12 th ed. Ch. 45. Texas: Mosby Publications; 2007. p. 478.  Back to cited text no. 1
    
2.Jain R, Sawhney S, Bhargava D, Berry M. Gallbladder tuberculosis: Sonographic appearance. J Clin Ultrasound 1995;23:327-9.  Back to cited text no. 2
[PUBMED]    
3.Yu R, Liu Y. Gallbladder tuberculosis: Case report. Chin Med J (Engl) 2002;115:1259-61.  Back to cited text no. 3
[PUBMED]    
4.Essop AR, Posen JA, Hodkinson JH, Segal I. Tuberculosis hepatitis: A clinical review of 96 cases. Q J Med 1984;53:465-77.  Back to cited text no. 4
[PUBMED]    
5.Kapoor S, Sewkani A, Naik S, Sharma S, Jain A, Varshney S. Myriad presentations of gall bladder tuberculosis. Indian J Gastroenterol 2006;25:103-4.  Back to cited text no. 5
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