A young 18 years old female came to the outpatient department. She presented with acute abdominal pain in the right iliac fossa. She had no past history of tuberculosis. Her vital systems were normal. On palpation of abdomen tenderness in the right iliac fossa was noted. Complete Hemogram was normal except neutrophilic leukocytosis. The chest radiograph was normal. Other relevant haematological and biochemical investigations were within normal limits. Her HIV status was nil. Ultrasonography reported an inflamed, oedematous blind loop in the right iliac fossa. Appendicitis was the clinical diagnosis; hence, appendectomy was planned. Intraoperative appendix was found to be inflamed. The resected appendectomy specimen was sent for histopathology. On gross, the appendix was measuring 6 cm in length and inflamed. One patchy grey/white area was identified measuring 0.5x0.5 cm (Fig. 1) on cutting open the lumen was obliterated due to a fecolith.
On microscopic examination, Hematoxylin and Eosin (H&E) stained sections revealed the mucosa, submucosa and serosa along with tubercular granulomas in the vicinity of serosa (Fig. 2a) consisting of poorly formed epithelioid cells granulomas and caseous necrosis (Fig. 2b). Ziehl Neelsen (ZN) stain for acid fast bacilli (AFB) was noncontributory (Fig. 3, 4). Based on location and histopathological examination, it was diagnosed as tubercular appendicitis Patient was started on antitubercular therapy for nine months (2HRZE/7HR) viz; nine months regime drug treatment having isonizid, rifampicin, pyrazinamide and ethambutol for two months followed by isonizid, rifampicin and ethambutol for seven months. The patient responded well to the treatment.
Informed consent was taken from the patient.