A case of tuberculosis presented by obstructive jaundice tuberculosis-related mechanical icterus

Abstract

Obstructive jaundice caused by tuberculosis lymphadenitis is a rare condition. It can mimic clinical and radiological findings of hepatobiliary malignancies. The authors report a 24-year-old male patient who presented with abdominal pain, fever and jaundice for the last two weeks. It was found that cholestasis enzymes were increased by 2-3 fold and direct bilirubin was 6.13 mg/dL. Imaging studies revealed conglomerated lymph nodes with some cavitary lesions and dilated intrahepatic biliary canal secondary to compression by the lymph nodes. Tuberculosis was found to be positive in the polymerase chain reaction analysis of the aspirate that was obtained in the guidance of imaging studies. M. tuberculosis complex was isolated from mycobacterial culture. Anti-tuberculosis treatment was initiated. Clinical, laboratory and radiological findings completely resolved by medical therapy alone. Tuberculosis lymphadenitis should be kept in mind in cases presenting with obstructive jaundice in endemic areas and interventional diagnostic techniques should be preferred in eligible patients.

Hemophagocytic Lymphohistiocytosis With Obstructive Jaundice as a Rare Presentation of Disseminated Tuberculosis in an Adult

“…Elevated levels of serum bilirubin and ALP, combined with the clinical manifestation of jaundice and the dilatation of intrahepatic biliary radicles, indicated the presence of obstructive jaundice. The underlying pathophysiology behind obstructive jaundice secondary to tuberculosis may be due to the inflammation and strictures of the main biliary duct, the compression of the bile duct, a tubercular mass on the pancreatic head, or a tuberculous abscess in the retroperitoneum [ 16 ]. In this patient, it is highly likely that the enlarged lymph node near the liver hilum was causing the compression of the biliary system, leading to the development of obstructive jaundice.…”

Obstructive Jaundice

“…Although it can be a sign of relatively nonlethal conditions such as Dubin Johnson syndrome, choledocholithiasis, red blood cell disorders, and drug-induced liver injury [2][3][4], it can also be a sign of more grievous diseases such as advanced pancreatic cancer, cholangiocarcinoma, biliary atresia, hepatocellular carcinoma, and liver metastases [5][6][7][8]. Jaundice can even be a sign of diseases such as tuberculosis lymphadenitis, autoimmune pancreatitis, cholangiohydatidosis, duodenal diverticulum (i.e., Lemmel's syndrome), duodenal ulcer, fascioliasis (i.e., parasitic disease caused by Fasciola hepatica), and coronavirus disease 2019 [9][10][11][12][13][14][15]. Moreover, obstructive jaundice can even cause endotoxemia because of intestinal barrier failure [16].…”