The Role of PCR in Diagnosis of a Rare Appendicular Tuberculosis and Mini Literature Review

Abstract

Tuberculosis is a prevalent public health problem especially in the poor developing countries and results in significant mortality. Albeit tuberculosis almost always affects any organ or system of the body, abdominal tuberculosis is less frequent; moreover, tuberculous appendicitis is very rare with an incidence estimated at about 0.1–0.6% of all gastrointestinal tuberculosis. The purpose of this report was to present an unusual case of primary tuberculous appendicitis and the approach used for accurate diagnosis as well as a current update on the disease. We are reporting a 30-year-old male who presented with acute abdominal pain, fever, and vomiting and was admitted with the clinical diagnosis of acute appendicitis. Patient was investigated thoroughly and histopathologic examination was strongly suggestive of tuberculous appendicitis; however, Ziehl-Neelsen (ZN) was negative in tissue section. To confirm the diagnosis, molecular biology [polymerase chain reaction (PCR)] study was performed from the formalin fixed paraffin embedded (FFPE) appendicular tissue and revealed presence of Mycobacterium tuberculosis. As there are numerous differential diagnoses in granulomatous lesions of appendix and due to the fact that appendicular tuberculosis is a rare phenomenon; verification etiologic agent is crucial for appropriate management of the disease.

Tuberculous appendicitis: A review of reported cases over the past 10 years

“…Thirty four cases of Tuberculous Appendicitis were reported in 27 papers [2] , [9] , [10] , [16] , [17] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] . Baseline characteristics are reported in Table 1 .…”

Tuberculous appendicitis. A case report

“…The dissemination can be haematogenous, through the lymphatic channel or from the adjacent foci [7,8]. TB appendicitis is a rare condition (about 0.1-0.2% of all acute appendicitis) and has no specific symptoms [9,10]. Our patient had a subacute onset.…”

Ancient foe spectra: Case series of Mycobacterium tuberculosis presentations

“…Notably, gastrointestinal tuberculosis accounts for 1%‐3% of all extrapulmonary TB forms while tuberculous appendicitis is extremely rare cited as only 0.1%‐0.6% of the cases 9 . The exact pathogenesis is not fully understood but hematogenous spread or extension from neighboring organs is the likely implicated source.…”