Acute cholecystitis complicated with gallbladder empyema due to Mycobacterium tuberculosis in a patient with diabetes mellitus: a case report

Abstract

Acute cholecystitis severity ranges from mild to very severe, and its most dreadful complication is gallbladder empyema. It can be caused by several etiologic agents, but Mycobacterium tuberculosis is not common among them. Here we present a 61-year-old female who lives in an area of high tuberculosis endemicity and has type 2 diabetes mellitus. She came to our hospital with a 2-day history of moderate-to-severe colicky right upper quadrant abdominal pain and other clinical manifestations compatible with AC. Imaging studies confirmed the diagnosis. An emergency open cholecystectomy was performed and the gallbladder was sent for histopathologic examination. M. tuberculosis was identified by molecular studies and the treatment was adjusted. The patient recovered uneventfully. The clinical history and physical examination are essential for raising the index of suspicion, but complementary evaluation with imaging studies is necessary to confirm the diagnosis and evaluate its complications. Tuberculosis is a major health problem worldwide, and health professionals should be aware of its clinical spectrum to approach and manage common and uncommon presentations within their scope of attention.

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…Manifestation on the gallbladder may present as a nodule, mass, or circumferential thickening with homogeneous or heterogeneous enhancement [69]. Calcification may be indicative of tuberculosis, as well as the involvement of the neighboring liver or lymph nodes [70,71]. An irregular heterogeneously enhancing thickened gall bladder wall has been described as a manifestation of tuberculosis [72,73].…”

Gallbladder Empyema: A Dreadly Complication of Acute Cholecystitis

“…Kolesistitis akut merupakan salah satu penyakit yang paling umum ditemui di Unit Gawat Darurat (UGD) yang harus ditatalaksana dengan pembedahan, yang merupakan penyakit inflamasi akut yang disebabkan oleh obstruksi saluran sistikus karena batu empedu atau empedu litpgenik (Ortiz-Hernández et al, 2022). Pada penelitian yang dilakukan di Departemen Bedah Rumah Sakit Pendidikan Kedokteran Assam, India didapatkan usia pasien dengan empiema kandung empedu berkisar antara 25 -71 tahun dengan insiden terbanyak terjadi pada kelompok umur 40 -60 tahun.…”

“…Empiema kandung empedu jarang terjadi namun penyakit ini merupakan komplikasi serius dari serius kolesistitis akut (Mehta et al, 2016;Ortiz-Hernández et al, 2022). Kolesistitis akut merupakan obstruksi duktus sistikus yang diakibatkan oleh adanya batu empedu sehingga menyebabkan inflamasi kimiawi atau bakteri pada kandung empedu (Halpin, 2014).…”