Primary tuberculous appendicitis presented with caecal perforation: a case report

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

According to the World Health Organization (WHO), tuberculosis (TB) is the 13th cause of death worldwide and the second infectious killer after HIV. It is an endemic disease in Morocco. Isolated appendicular TB is an uncommon form of extrapulmonary TB. We report a case of a 26-year-old woman admitted for acute abdominal pain in the right iliac fossa with fever, vomiting, and diarrhea. Physical examination and abdominal ultrasound confirmed appendicitis. Surgery was performed and revealed on histopathological examination of the resected appendix the diagnosis of tubercular appendicitis. The patient was initiated on the conventional antitubercular regimen for six months and would be followed up appropriately. This case report highlights the importance of histopathological examination of appendicectomy specimens in order to diagnose rare diseases such as primary TB of the appendix.

First case of primary appendiceal tuberculosis presented as stump appendicitis

Tuberculosis (TB) remains as a significant global public health issue, especially in developing and underdeveloped nations. Extrapulmonary TB comprises 20% of the TB cases; of which 34.4% were in the lymphatics, 25.2% pleural, followed by 12.8% gastrointestinal and 9.4% in the central nervous system. Ileocecal involvement is the most common among gastrointestinal TB. Although it can cause secondary damage to the appendix, primary type of appendicular TB is rare and can occur with no other signs of the disease. A high index of suspicion is necessary for early diagnosis and treatment of TB. Similarly, stump appendicitis (SA) is a rare and delayed complication of appendectomy. Here we report a case of primary appendicular TB in a patient presented to a multi-specialty hospital in Kerala, India, with SA.

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

BACKGROUND

Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear summarization or consensus on its management.

DATA SOURCES

Case reports were gathered from several online literature databases by searching terms "tuberculosis", "tuberculous", and "appendicitis".Report eligibility criteria: Cases of appendicitis due to M. tuberculosis identified on operative histology. Exclusion criteria: appendicitis caused by a mycobacterium other than M. tuberculosis, and appendiceal tuberculosis identified incidentally during procedures for other reasons.

RESULTS

Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in 15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment (ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months.

LIMITATIONS

Data was gathered from case reports without complete uniformity in diagnostic work-up. The potential for larger scale study is limited due to disease rarity.

CONCLUSIONS

Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points may suggest the disease on a clinician's differential diagnosis if they present with a combination of the following: born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young patient; positive AFB stain of abdominal fluid or peritoneal tissue.