摘要
Tuberculosis （TB） is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. We report a 56-year-old man presented with jaundice, weight loss and poor appetite. Initial work up showed the dilated biliary system secondary to distal common bile duct stricture. Investigations to define the etiology of this stricture showed inconclusive brush cytology with absent abdominal masses and lymph nodes but enlarged mediastinal lymph nodes. Biopsy from these lymph nodes showed a non-caseating epitheliod granuloma with negative acid fast bacilli （AFB） stain. The patient had a dramatic response to empirical antituberculosis therapy. Six weeks later, culture from lymph nodes was positive for Mycobacteriurn tuberculosis. Three months later, follow-up cholangiogram showed complete resolution of the stricture with normalization of liver enzymes 6 mo after starting anti-tuberculosis therapy. Treatment was continued for 12 mo and the patient had a normal life with normal liver enzymes and regression of the mediastinal lymph nodes at the time when he was reported in this paper. Although 16 cases of tuberculous biliary stricture are available in the English literature, up to our knowledge, this is the second published report of tuberculous biliary stricture, which resolved completely after medical therapy alone 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.
肺结核(TB ) 是是困难的诊断并且通常要求外科的干预以便排除位于恶意的病原学下面的胆汁的苛评的一个很稀罕的原因。我们报导与黄疸，重量损失和差的胃口介绍的一个 56 岁的人。起始的工作在上面显示出对远侧的胆总管苛评第二等的扩大胆汁的系统。定义这苛评的病原学的调查与不在的腹的群众和淋巴节点显示出不确定的刷子细胞学，但是扩大了纵隔淋巴节点。从这些淋巴结的活体检视证明有否定的酸 fast 杆菌(AFB ) 的乾酪化得非的 epitheliod 肉芽肿染色。病人有戏剧的回答到实验反肺结核治疗。六个星期以后，从淋巴结的文化为 Mycobacterium 是积极的。三个月以后，后续胆管造影照片与肝酶的正规化显示出苛评的完全的分辨率在开始反肺结核以后的 6 瞬间治疗。治疗为 12 瞬间被继续，病人在他在这篇论文被报导的时间与正常的肝酶和纵隔淋巴节点的回归过了正常生活。尽管有结节的胆汁的苛评的 16 个案例在英语文学是可得到的，直到我们的知识，这是有结节的胆汁的苛评的第二份出版报告，它从中东在独自一个的医药治疗和第二个报导案例以后完全解决了。这份报告强调作为胆汁的苛评的可能性把 TB 放在世界的这部分的重要性。
