Primary Tuberculosis of the Appendix: A Case Report

Abstract

A woman in her thirties visited our hospital complaining of right lower abdominal pain and fever. Abdominal CT showed an enlarged appendix and we made the diagnosis of acute appendicitis. Despite conservative treatment, the inflammation recurred after 3 weeks, and we performed an appendectomy. Intraoperatively, only local inflammatory changes were observed, with no abscess formation or white nodules suggestive of active tuberculous peritonitis. Postoperative histopathology revealed epithelioid granulomas with caseous necrosis and Langhans-type giant cells in the appendix wall, confirming active appendiceal tuberculosis. However, as chest CT, smear test for acid-fast bacilli, mycobacterial culture, PCR assay, and interferon-γ release assay revealed no evidence of active tuberculous infection, the patient was not initiated on anti-tuberculosis therapy. The patient’s postoperative course was satisfactory and she was discharged on the 10th postoperative day. Endoscopic examinations of the upper and lower gastrointestinal tract were performed later, which also revealed no tuberculous lesions. Therefore, the patient was diagnosed as having primary tuberculosis of the appendix. Nine months after the surgery, the patient remains in good general condition. Primary tuberculosis of the appendix is rare, and there have been only three case reports in Japan.