Resolution of tuberculous biliary stricture after medical therapy.
Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. We report a 56-year-old man presented with jaundice, weight loss and poor appetite. Initial work up showed the dilated biliary system secondary to distal common bile duct stricture. Investigations to define the etiology of this stricture showed inconclusive brush cytology with absent abdominal masses and lymph nodes but enlarged mediastinal lymph nodes. Biopsy from these lymph nodes showed a non-caseating epitheliod granuloma with negative acid fast bacilli (AFB) stain. The patient had a dramatic response to empirical anti-tuberculosis therapy. Six weeks later, culture from lymph nodes was positive for Mycobacterium tuberculosis. Three months later, follow-up cholangiogram showed complete resolution of the stricture with normalization of liver enzymes 6 mo after starting anti-tuberculosis therapy. Treatment was continued for 12 mo and the patient had a normal life with normal liver enzymes and regression of the mediastinal lymph nodes at the time when he was reported in this paper. Although 16 cases of tuberculous biliary stricture are available in the English literature, up to our knowledge, this is the second published report of tuberculous biliary stricture, which resolved completely after medical therapy alone and the second reported case from the Middle East. This report emphasizes the importance of keeping TB as a possibility of biliary stricture in this part of the world.
Alsawat
Khalid E
KE
Division of Gastroenterology, King Khalid University Hospital, Riyadh 11321, Po box 231494, Saudi Arabia.
Aljebreen
Abdulrahman M
AM
D000995:Antitubercular Agents / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D015431:Weight Loss
D000995:Antitubercular Agents