Appendicular tuberculosis: The resurgence of an old disease with difficult diagnosis

Abstract

Gastrointestinal tuberculosis (TB) is quite rare, representing only 3% of all extra-pulmonary cases. Blind gut and ileum are the most common gastrointestinal localizations, while appendix involvement is infrequent. Appendix involvement is usually related to symptoms of acute appendicitis since the caseous necrosis may lead to adhesions and surgical complications such as perforation. For this reason patients with suspected appendicular TB usually undergo surgery even without a secure diagnosis. In these cases, due to the absence of specific symptoms and signs, the diagnosis is delayed after surgery, thus resulting in a high percentage of important, and sometimes lethal, complications. Histopathological examination is often the only way to reach a diagnosis and to establish specific antibiotic therapy, while an early diagnosis could avoid surgical treatment. We report a case of appendicular TB not only for its rarity but also to discuss the difficulty in its diagnosis.

Appendicular tuberculosis: review of 155 published cases and a report of two cases

“…According to the WHO report of 2009, one-third of the world's population are infected with TB bacilli, and nine million new cases are being added each year [4]. Since 1946, TB has been effectively managed with antimicrobial treatment; however, a new rise in TB infection is being observed, which may be due to HIV infection (which is becoming an endemic problem), the use of immunosuppressive agents for various reasons, and the development of resistance to anti-TB drugs [4,8,19].…”

“…Since 1946, TB has been effectively managed with antimicrobial treatment; however, a new rise in TB infection is being observed, which may be due to HIV infection (which is becoming an endemic problem), the use of immunosuppressive agents for various reasons, and the development of resistance to anti-TB drugs [4,8,19]. Not surprisingly, there is also an increase in the percentage of patients with atypical presentations and atypical extrapulmonary forms of TB (EPTB).…”

“…EPTB accounts for 10-15% of TB in the general population, while this ratio ranges from 19 to 70% in HIV-endemic regions [6,8,19]. The most common forms of EPTB are tuberculosis of the bones (30%), urinary system (24%), lymph nodes (13%), genital system (8%), cerebrospinal meninges (4%), and digestive system (3%) [4][5][6]. EPTB can affect any part of the gastrointestinal tract.…”

“…The secondary form, which is well known, may be either ileocecal, genital tuberculosis, or tuberculosis elsewhere in the body [2,4,6,20,26,27]. The incidence of secondary ATB varies from 1.5 to 3.0% [24,28].…”

“…TB may affect all of the tissues and organs in the body, but it most frequently involves the lungs. The gastrointestinal system is ranked sixth among all extrapulmonary involvements, with a prevalence rate of 3%; concomitant active pulmonary TB is present in only 25% of those patients [4][5][6][7]. TB may affect all of the segments of the gastrointestinal system, from the mouth to anus.…”