Obstructive Jaundice Due to Periportal Tuberculous Lymphadenopathy in a Patient With Multidrug-Resistant (MDR)...

Extrapulmonary tuberculosis is a common manifestation of tuberculosis, with lymph node involvement being the most frequent form. Among its presentations, periportal lymph node involvement leading to obstructive jaundice is extremely uncommon. Jaundice developing during anti-tubercular therapy (ATT) is frequently ascribed to drug-induced hepatotoxicity, which may contribute to delays in accurate diagnosis. We report a 17-year-old male with multidrug-resistant (MDR) lymph node tuberculosis who presented with progressive jaundice and right upper quadrant abdominal pain. Laboratory evaluation showed marked conjugated hyperbilirubinemia and cholestatic enzyme elevation. Ultrasonography, contrast-enhanced computed tomography (CECT), and magnetic resonance cholangiopancreatography (MRCP) revealed a large periportal and peripancreatic coalescent lymph nodal mass compressing the common bile duct (CBD), causing upstream biliary dilatation. Differential diagnoses included drug-induced hepatitis and cholangiocarcinoma, but radiology favored tuberculous lymphadenitis. The patient underwent percutaneous transhepatic biliary drainage (PTBD), with significant clinical improvement. He was subsequently restarted on the all-oral longer MDR regimen under careful monitoring. Obstructive jaundice due to tuberculous lymphadenopathy is a rare but important entity that may mimic drug-induced hepatitis or malignancy. Early imaging, biliary decompression, and individualized ATT modification are crucial. This case also highlights the rise and fall pattern associated with evolving drug resistance.