Published online Mar 27, 2020. doi: 10.4240/wjgs.v12.i3.123
Peer-review started: October 14, 2019
First decision: November 6, 2019
Revised: November 20, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: March 27, 2020
Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections. There are reports of gallbladder tuberculosis mimicking cholecystitis or malignancy. However, these presentations were chronic. The diagnosis of gallbladder tuberculosis warrants the need for investigation of additional sites of inoculation and contact tracing of all tuberculosis contacts. Gallbladder tuberculosis is a rare entity but should be suspected in patients from endemic regions with risk factors such as underlying immunosuppression or history of tuberculosis.
We present a case of gallbladder tuberculosis presenting as acute cholecystitis. A 44-year-old Filipino lady presented with a 11-d history of right hypochondrium and epigastric pain which worsened after meals with no significant past medical history. She underwent laparoscopic cholecystectomy on the presumptive diagnosis of acute cholecystitis and diagnosed as gallbladder tuberculosis after histopathological examination. The patient did not have features of pulmonary or systemic tuberculosis nor was she immunocompromised. She recovered uneventfully. She was subsequently discharged and followed-up at a hospital in her home country due to financial and social reasons.
Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis.
Core tip: Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections. We present a rare case of isolated gallbladder tuberculosis presenting as acute cholecystitis. Clinical examination revealed positive Murphy’s sign. The patient underwent laparoscopic cholecystectomy within the same admission. Histology shows necrotizing granulomatous inflammation with rare acid-fast bacilli which was identified on Ziehl-Neelsen stain. This case highlights the multivariable clinical presentations of gallbladder tuberculosis. Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis to obtain a pre-operative diagnosis.