Abstract
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 anti-tuberculosis therapy.Six weeks later,culture from lymph nodes was positive for Mycobacterium 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