Intestinal Tuberculosis: A Diagnostic Challenge

Abstract

Diagnosing intestinal tuberculosis (TB) with uncommon clinical manifestations is often challenging. Here, we report a case of an alcoholic patient who presented with vague symptoms and was later diagnosed with intestinal TB. This patient experienced multiorgan failure causing hemodynamic instability requiring ionotropic support; acute hypoxic respiratory failure managed with non-invasive positive pressure ventilation, hepatic failure, transudative peritoneal effusion, and transudative pleural effusion. These conditions clouded our judgment to pursue colonoscopy for a definite diagnosis and delayed the anti-tuberculosis treatment. When intestinal tuberculosis TB is suspected, the differential diagnosis must be established with other gastrointestinal involving diseases, including mycobacterium avium complex (MAC) and Crohn's disease (CD). MAC can show overlapping features with intestinal TB or coexist with it; Acid-fast stain and tissue culture are the key tests to differentiate these two. In the presence of diagnostic uncertainty between intestinal TB and CD, a therapeutic trial with anti-tuberculous therapy may be warranted.

Intestinal tuberculosis masquerading as carcinoma colon: a case report of diagnostic quandary in low-resource setting

“…On gross examination, apart from typical tuberculous lesions in the form of transverse ulcers, strictures, hyperplastic lesions and serosal tubercles, intestinal perforation and ischemic bowel are identified too [ 3 ]. The diagnosis of the extra-pulmonary TB remains challenging due to the inconspicuous endoscopic and radiographic findings [ 4 ].…”

Ileocaecal Tuberculosis Presenting with Massive Hematochezia: A Rare Clinical Manifestation

“…The diagnosis becomes more difficult in the absence of active pulmonary tuberculosis. The correct diagnosis is only 50% even in prevalent areas [ 8 ]. In undeveloped countries like Nepal, where the loss to follow-up is a big concern, delays in prompt diagnosis and treatment lead to severe morbidity and mortality [ 9 ].…”

“…Due to mimicking with other diseases such as Crohn's disease, a malignancy [ 3 ], misdiagnosis can lead to delay in treatment of other diseases as well as unnecessary drug toxicity from antitubercular therapy. Similarly, therapy with immunosuppressants in intestinal tuberculosis considering Crohn's disease can cause a flare up of tuberculosis and significant morbidity and mortality [ 8 ]. A single cost-effective investigation is still not available for intestinal tuberculosis, and the diagnosis reached on the therapeutic basis in 20% of cases [ 15 ].…”

A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man

“…Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. 10 , 11 , 13 , 15 , 17 , 18 On gross appearance, there are three types of lesions of intestinal TB: ulcerative (60%), hypertrophic/hyperplastic (10%), and ulcero-hypertrophic types (30%). The hypertrophic type is the less frequent form that causes luminal narrowing and intestinal obstruction.…”

“…Preoperative diagnosis of intestinal TB is challenging, particularly in resource-limited settings. 1 , 3 , 6 , 11 , 13 , 16 , 17 , 19…”