JURNAL RESPIRASI, SEPTEMBER 2021, VOL 07 (03); 122-126 Appendicular Tuberculosis as Manifestation of Gastrointestinal Tuberculosis: A Case Report Yuliza 1 , Alfian Nur Rosyid 1,2 * , Wiwin Is Effendi 1,2,3 , Prastuti Asta Wulaningrum 2 , Herley Windo Setiawan 2 1 Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga 2 Universitas Airlangga Hospital, Surabaya, Indonesia. 3 Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan. ARTICLE INFO ABSTRACT Article history: Received 03 November 2020 Received in revised form 26 September 2021 Accepted 28 September 2021 Available online 30 September 2021 Introduction: Gastrointestinal tuberculosis (GI TB) is quite rare with 3% incidence of all extrapulmonary involvement. Appendicular TB may occur in 0.1 - 3% of cases. Diagnosis is often difficult because the patient usually complains about chronic abdominal pain and fever. A definite diagnosis is based on histopathological examination of resected specimens from the appendectomy procedure. Case: We present a 37-year-old male patient admitted to the hospital with chronic abdominal pain, fever, nausea, and loss of body weight. The patient never had a persistent cough, hemoptysis, or night sweating. Physical examination showed pain and muscular rigidity in the right iliac area during palpation with Blumberg's sign and Rovsing's sign positive. Abdomen ultrasound imaging showed an appendicular abscess. The patient underwent appendectomy afterwards with histopathology result showing TB. The patient was treated with first category anti-tuberculosis drugs (ATD). Discussion: Diagnosis of appendicular TB is difficult due to unspecific clinical presentations. Appendicular TB patients often complain of signs and symptoms which are similar to acute appendicitis. These conditions can delay ATD treatment because the definitive diagnosis could be made after histopathological examination. Summary: Appendicular TB is a rare case of extrapulmonary TB. It can present as acute appendicitis. The definitive diagnosis is based on the histopathological examination. It is recommended to check the appendicectomy specimens histopathologically to exclude TB or other diseases. Keywords: Appendicular tuberculosis, Histopathological examination, Infectious disease, Surgery, Tuberculosis. INTRODUCTION Tuberculosis (TB) is a major health problem which becomes one of the top 10 cause of death worldwide and the leading cause of death from a single infectious agent. TB is caused by Mycobacterium tuberculosis (MTB) which is transmitted from person to person through coughing, sneezing, or speaking. 1 More than 80% of TB disease affects the lungs (pulmonary TB), but it can also affect other sites (extrapulmonary TB) which spreads to these organs through 5 ways: (1) sputum ingestion by a patient with active pulmonary disease from MTB, (2) hematogenous spread from a distant focus, (3) lymphatic spread through infected nodes, (4) direct extension from a contiguous site, and (5) ingestion of milk products infected with Mycobacterium bovis when drinking raw milk. 2 Globally, an estimate of 10 million people were infected with TB in 2019, 16% of which were extrapulmonary TB. Several studies reported the highest percentage of extrapulmonary TB are in Brazil (45.6%), England and Wales (41%), Iran (27.3%), North India (27.3%), Korea (20.4%), and United States (18,7%). Meanwhile in Indonesia, the insidence is unclear. 3 TB can also affect the gastrointestinal tract, called gastrointestinal TB (GI TB), and play an important role for TB-related morbidity and mortality. 4 *Corresponding author: alfian-n-r-10@fk.unair.ac.id CASE REPORT 122 Jurnal Respirasi, p-ISSN: 2407-0831; e-ISSN: 2621-8372. Accredited No. 200/M/KPT/2020; Available at https://e-journal.unair.ac.id/JR. DOI: 10.20473/jr.v7-I.3.2021.122-126 This work is licensed under a Creative Commons Attribution-Share Alike 4.0 International License.