Intestinal tuberculosis in immunocompetent/HIV negative patients: case report of two patients

Brambilla, E; Ponte, Marcos Dal; Ruschel, Leonardo Gilmone; Silva, Pedro Guarise da

doi:10.1590/s2237-93632012000300015

Cited by 2 publications

(8 citation statements)

References 15 publications

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“…Though the deficient immune response among immunosuppressed patients can elevate the incidence and the severity of ITB, 18 in rare cases, it would appear in a healthy immune system, such as in Brambilla et al’s report. 2 Our case had a 30-year history of RA using hydrocortisone and prednisolone with self-discontinuation of MTX. There was no evidence of latent TB existence, based on no history of the tuberculin skin test; however, being infected with TB in our endemic region is not unexpected.…”

Section: Discussionmentioning

confidence: 87%

“…Tuberculosis (TB) remains a major health problem in developing countries. 1 Regarding the advent of effective therapy, 2 the probability of the rare extrapulmonary tuberculosis is not negligible. 3 Intestinal TB (ITB) is the sixth most common extrapulmonary presentation 4 with notorious innate which should be considered before a definite diagnosis, especially in areas where TB is prevalent.…”

Section: Introductionmentioning

confidence: 99%

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Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis

Mansour-Ghanaei¹,

Joukar²,

Samadi³

et al. 2018

IMCRJ

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IntroductionTuberculosis (TB) is one of the endemic diseases with a challenging diagnosis in the absence of pulmonary disease. On the other hand, rheumatoid arthritis (RA) is a systemic autoimmune disease with extra-articular manifestations that occur at any age after onset, such as nodules, Sjögren’s syndrome, anemia of chronic disease, and pulmonary manifestations, which are more frequently seen in patients with severe, active disease. Here we present a case of RA with intestinal TB.Case reportA 55-year-old woman with a 30-year history of RA using prednisolone and hydroxychloroquine presented with a nonpositional hypogastric pain and a weight loss of 20 kg over 7 months. No history of biological therapy was recorded. Colonoscopy revealed an ulcerated mass that was suspicious for malignancy. The pathobiological assessments confirmed ulceration and granulation tissue formation, foci of necrotizing granulomatous inflammation in lamina propria with adjacent mild crypt regenerative changes. Also, Ziehl–Neelsen staining for acid-fast bacilli in the granulomas was positive though the polymerase chain reaction assay did not detect the Mycobacterium tuberculosis. Anti-TB medication for 2 weeks eliminated the symptoms.ConclusionsIntestinal TB in patients with vague abdominal symptoms and relevant physical findings such as pain and palpable mass should be considered to prevent late or misdiagnosis.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis

Mansour-Ghanaei¹,

Joukar²,

Samadi³

et al. 2018

IMCRJ

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“…The most common site of intestinal TB is ileocecal region (in around 85% of the cases), followed by jejunum and colon; duodenal involvement is seen in less than 3% of all GI TB cases [ 4 , 7 ]. Our patient had involvement of the colon, and probably of the appendix.…”

Section: ⧉ Discussionmentioning

confidence: 99%

“…Low digestive hemorrhage is rare. Physical examination may show palpable abdominal mass [ 1 , 3 , 5 , 7 , 12 , 13 , 14 , 15 , 16 ]. Our patient was repeatedly seen by the surgeon as the main presentation was persistent, important abdominal distension and pain.…”

Section: ⧉ Discussionmentioning

confidence: 99%

“…Positive purified protein derivative (PPD) tuberculin tests only mean infection, not disease, so a TB diagnosis may not be based on a positive skin test. Polymerase chain reaction (PCR) detection of Mycobacterium deoxyribonucleic acid (DNA) may provide a fast diagnosis of extrapulmonary TB, with specificity of 100% and sensitivity ranging from 64% to 86% [ 1 , 7 ]. Despite rigorous investigations, bacterial isolation is only possible in about half the cases, as the literature states.…”

Section: ⧉ Discussionmentioning

confidence: 99%

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The diagnostic challenges in a child with intestinal tuberculosis

Vlad

Smădeanu²,

Becheanu³

et al. 2022

Rom J Morphol Embryol

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Introduction: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. Case presentation: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient's food. The child's pulmonary X-ray was normal, but the mother's was suggestive for pulmonary TB. The QuantiFERON ® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O/Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. Conclusions: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.

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Intestinal tuberculosis in immunocompetent/HIV negative patients: case report of two patients

Cited by 2 publications

References 15 publications

Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis

Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis

The diagnostic challenges in a child with intestinal tuberculosis

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