Primary tuberculosis of cystic duct lymph node

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pathology

Background:

• Tuberculosis (TB) is a major global health concern, causing significant morbidity and mortality.
• Isolated cystic duct lymph node TB, without gallbladder involvement, is exceptionally rare.
• Preoperative diagnosis of TB in this presentation is challenging due to nonspecific symptoms.

Observation:

• A 45-year-old male presented with 1 week of right upper abdominal pain, nausea, and postprandial fullness.
• Physical examination revealed right upper quadrant tenderness, positive Murphy's sign, and splenomegaly.
• Abdominal ultrasound showed gallbladder sludge, a dilated pancreatic duct, coarse liver texture, and splenomegaly, with no lymphadenopathy.

Findings:

• Laparoscopic cholecystectomy was performed.
• Histological examination confirmed chronic caseating granulomatous lymphadenitis with Langhans giant cells in the cystic duct lymph node.
• The gallbladder showed chronic cholecystitis.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of isolated cystic duct lymph node enlargement.
• The findings emphasize the diagnostic challenges and the need for thorough histopathological examination.
• Successful treatment with standard anti-tuberculosis therapy for 12 months was achieved.