Primary tuberculosis of the appendix in a young male patient: Report of a case

Abstract

A 23-year-old man without a history of tuberculosis presented with right lower abdominal pain and a fever. An increased inflammatory response was found, and abdominal computed tomography showed a diffuse enlargement and wall thickening in the appendix. An ileocecal abscess and perforating appendicitis were suspected. Therefore, an emergency operation was performed. The surgery revealed a diffuse enlargement with adhesion to the retroperitoneum, which was suspected to be a neoplastic lesion of the appendix, thus an ileocecal resection including the appendix was performed. A histopathological examination revealed a number of epithelioid granulomas having Langerhans giant cells with caseous necrosis in the appendix, in addition to many granulomas without caseous necrosis in the regional lymph nodes. No tubercle bacilli were detected by Ziehl-Neelsen staining. Further examination revealed no tubercular lesions in other organs, thus leading to the diagnosis of primary tuberculosis of the appendix. This is an extremely rare disease reported in Japan.

A Rare Case of Tuberculosis Revealed by Acute Appendicitis: A Case Report

“…Macroscopically, the appendix can be normal, ulcerative, or hypertrophied [ 18 ]. Histopathological examination reveals a tuberculous granuloma with central caseous necrosis surrounded by multiple Langhans-type giant cells located in the appendix, which is pathognomonic of TB (Figures 3 , 4 ).…”

An unusual case of appendicitis

“…6 First described in 1837, appendicular TB is quite rare, with about 70 case reports published in English. 7 Foreign-born individuals from TB-endemic regions and Aboriginal Canadians have a higher risk of TB infection, as do close contacts of an individual with known TB disease. Tuberculosis should be considered in all patients with abdominal pain, fever and nonliver related ascites, if they fit the epidemiological profile noted above.…”

Primary tuberculosis appendicitis with mesenteric mass

“…The incidence of primary tuberculous appendicitis was reported as 0.26% by Mittal et al [7], 0.6% by Singh et al [8], 2.3% by Gupta [7] in India and 0.13% by Sohn et al [6] in Korea. In Japan, until 2010, primary TB of the appendix was observed in only 11 out of 29 cases of all TB of appendix [9]. It seems that primary tuberculous appendicitis is extremely rare.…”

“…This makes pre-operative diagnosis difficult and delayed, resulting in a high percentage of complicated appendicitis. Borow and Friedman suggested three clinical features: 1) the chronic form-mild to moderate right quadrant abdominal pain, with nausea and vomiting, 2) the acute form-sudden onset of right quadrant abdominal pain, 3) the latent form [8,9]. …”