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Tuberculosis (TB) is a very rare cause of biliary stricturethat is difficult to diagnose and usually requires surgicalintervention in order to rule out underlying malignantetiology.We report a 56-year-old man presented withjaundice,weight loss and poor appetite.Initial work upshowed the dilated biliary system secondary to distalcommon bile duct stricture.Investigations to definethe etiology of this stricture showed inconclusive brushcytology with absent abdominal masses and lymph nodesbut enlarged mediastinal lymph nodes.Biopsy fromthese lymph nodes showed a non-caseating epitheliodgranuloma with negative acid fast bacilli(AFB)stain.The patient had a dramatic response to empirical anti-tuberculosis therapy.Six weeks later,culture from lymphnodes was positive for Mycobacterium tuberculosis.Three months later,follow-up cholangiogram showedcomplete resolution of the stricture with normalizationof liver enzymes 6 mo after starting anti-tuberculosistherapy.Treatment was continued for 12 mo and thepatient had a normal life with normal liver enzymes andregression of the mediastinal lymph nodes at the timewhen he was reported in this paper.Although 16 cases of tuberculous biliary stricture areavailable in the English literature,up to our knowledge,this is the second published report of tuberculous biliarystricture,which resolved completely after medicaltherapy alone and the second reported case from theMiddle East.This report emphasizes the importance ofkeeping TB as a possibility of biliary stricture in this partof the world.
Tuberculosis (TB) is a very rare cause of biliary stricturethat is difficult to diagnose and usually require surgical intervention in order to rule out underlying malignantetiology. We report a 56-year-old man presented with jaundice, weight loss and poor appetite.Initial work upshowed the dilated biliary system secondary to distalcommon bile duct stricture. Investigations to define the etiology of this stricturepted inconclusive brushocytology with absent abdominal masses and lymph nodes but enlarged mediastinal lymph nodes. Biopsy fromthese lymph node showed a non-caseating epithelioggryuloma with negative acid fast bacilli (AFB) stain.The patient had a dramatic response to empirical anti-tuberculosis therapy. Six weeks later, culture from lymphnodes was positive for Mycobacterium tuberculosis. Three months later, follow-up cholangiogram showed complete resolution of the stricture with normalizationof liver enzymes 6 mo after starting anti -tuberculosistherapy.Treatment was continued for 12 mo and thepatient had a normal life with normal liver enzymes andregression of the mediastinal lymph nodes at the timewhen he was reported in this paper.Although 16 cases of tuberculous biliary stricture areavailable in the English literature, up to our knowledge, this is the second published report of tuberculous biliarystricture, which resolved completely after medical treatment of and the second reported case from the Middle East. This report emphasizes the importance of keeping TB as a possibility of biliary stricture in this part of the world.