BMJ Case Reports 2017; doi:10.1136/bcr-2016-218804
  • Rare disease

Primary tuberculosis of cystic duct lymph node

  1. Iram Hassan1
  1. 1Department of General Surgery, KRL Hospital, Islamabad, Pakistan
  2. 2Department of Epidemiology, KRL Hospital, Islamabad, Pakistan
  1. Correspondence to Dr Naqeeb Ullah Khan, naqeeb16{at}
  • Accepted 29 May 2017
  • Published 16 June 2017


Tuberculosis (TC) is very common and significant cause of morbidity and mortality worldwide. Isolated cystic duct lymph node TC cases without involvement of gallbladder are exceedingly rare. It is difficult to diagnose preoperatively because of lack of characteristic signs and symptoms of TC. We report a man aged 45 years who presented with right upper abdominal pain since 1week. It was associated with nausea and postprandial fullness. There was no evidence of jaundice and lymphadenopathy. Abdominal examination showed moderate right upper quadrant tenderness with positive Murphy's sign and splenomegaly but no signs of peritonism. Abdomen ultrasound revealed sludge in gallbladder, dilated pancreatic duct, coarse exotexture of liver, splenomegaly and no lymphadenopathy. He underwent laparoscopic cholecystectomy; histological report showed chronic caseating granulomatous lymphadenitis with Langhans type of giant cells in lymph node near cystic duct with chronic cholecystitis of gallbladder. Standard antituberculosis therapy was given for 12 months.


  • Contributors AG operated the case and selected it for publication. He also contributed in the drafting and final revision of the document. AA wrote the abstract, case presentation, investigations and treatment sections of this article. NUK is a consultant epidemiologist who critically reviewed the whole manuscript, edited and drafted the manuscript again and gave a final touch to the report and made it ready for publication. IH did extensive literature search for this case report. She also wrote the Discussion section and provided the references for the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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