Korean J Gastroenterol.  2014 Jan;63(1):51-55. 10.4166/kjg.2014.63.1.51.

A Case of Gallbladder Tuberculosis Diagnosed by Positive Tuberculosis-Polymerase Chain Reaction

• Ryu MJ
• Jeon TJ
• Park JY
• Choi Y
• Baek SS
• Sinn DH
• Oh TH
• Kim JY

• KMID: 1711307
• DOI: http://doi.org/10.4166/kjg.2014.63.1.51

Abstract

Gallbladder tuberculosis is an extremely rare disease that is rarely reported in the literature. Arriving at the correct diagnosis of gallbladder tuberculosis is difficult, and it is usually made by histopathologic examination after cholecystectomy. However, due to the low sensitivity of acid-fast stain and culture result, diagnosing gallbladder tuberculosis is still demanding even after tissue acquisition. To overcome this problem, tuberculosis-polymerase chain reaction (TB-PCR) is performed on the resected specimen, which has high sensitivity and specificity. A 70-year-old female who had previously undergone total gastrectomy for advanced gastric cancer was admitted with right upper quadrant pain. Abdominal ultrasonography and computed tomography revealed acute cholecystitis without gallstones or sludge. She underwent cholecystectomy and the histopathologic finding of the specimen showed chronic active cholecystitis without gallstones or sludge. Because she was suspected to have pulmonary tuberculosis, TB-PCR was also performed on the resected gallbladder. TB-PCR showed positive reaction for Mycobacterium tuberculosis and we could diagnose it as gallbladder tuberculosis. Herein, we present a case of gallbladder tuberculosis diagnosed by TB-PCR from resected gallbladder.

Keyword

Gallbladder; Tuberculosis; Polymerase chain reaction

MeSH Terms

Aged
Antitubercular Agents/therapeutic use
Cholecystitis, Acute/*diagnosis/surgery/ultrasonography
DNA, Bacterial/analysis
Female
Humans
Mycobacterium tuberculosis/genetics/isolation & purification
Polymerase Chain Reaction
Tomography, X-Ray Computed
Tuberculosis/*diagnosis/drug therapy/microbiology
Antitubercular Agents
DNA, Bacterial

Figure

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  Fig. 1. (A) Chest X-ray shows increased nodular opacity in left upper lobe. (B) Chest CT reveals a 4-cm-sized irregular low attenuated consolidative lesion in left upper lobe.

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  Fig. 2. Abdominal CT shows distended gallbladder with diffuse gallbladder wall thickening, hyperemic change of adjacent liver parenchyma, and extrahepatic duct dilatation. The CT scan also shows mild swelling of pancreas head and peripancreatic fat infiltration.

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  Fig. 4. Nested-PCR for Mycobacterium tuberculosis. To eliminate any possibility of cross contamination from M. tuberculosis (MTB) positive control PCR, amplicon size 745 bp of the positive control PCR was desinged. The internal control is 520 bp in the first and second (nested) PCR. Normally, the first PCR product (255 bp) does not show up but could very rarely be generated in the presence of high titer M. tuberculosis. In our patient (lane 2), 255 bp band is also not detected on first PCR. However, the second (nested) PCR assay shows positive reaction for M. tuberculosis (190 bp). Lanes 1, 3, 4 are samples from other patients. N, negative control lane; P, positive control lane; L, ladder (molecular weight marker).

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  Fig. 3. Histopathologic findings of the resected gallbladder (H&E). (A) Necrotic change is seen on the resected gallbladder mucosa (×100). (B) The necrotic lesion is composed of aggregates of epithelioid histiocytes (×400).

Reference

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