Gallbladder and liver miliary nodules: a surprising diagnosis of disseminated tuberculosis during emergency laparoscopic cholecystectomy.

Abstract

Background: Disseminated tuberculosis (TB) presenting as miliary nodules on the gallbladder and liver is extremely rare and poses significant diagnostic challenges. This report describes a case of disseminated TB discovered during emergency laparoscopic cholecystectomy for acute cholecystitis.

Case presentation: A 77-year-old male presented with decreased appetite, weight loss, and fever. Preoperative imaging suggested gallstones and cholecystitis. During surgery, multiple miliary nodules were found on the surfaces of the gallbladder and liver, raising suspicion of metastatic cancer. Intraoperative frozen pathology revealed epithelioid granulomas with necrosis, and postoperative molecular testing confirmed Mycobacterium tuberculosis.

Conclusions: This case highlights the importance of considering TB in the differential diagnosis of intra-abdominal nodules, especially in TB-endemic regions. Intraoperative frozen pathology and molecular diagnostics are crucial for timely and accurate diagnosis.