Extrapulmonary tuberculosis as a cause of complex perianal fistula disease.

Extrapulmonary tuberculosis (TB) in the gastrointestinal tract is a rare, but yet an essential differential diagnosis to patients with complex fistula disease, since the initiation of immunosuppressive therapy for presumed Crohn's disease can lead to a fulminant course of TB. This case report presents a young Danish woman with a progressive complex fistula disease, where cause and treatment were uncovered by interprofessional collaboration between pulmonologists, gastroenterologists and surgeons including a screening test for TB as well as multiple biopsies from the anal fistula tissue.

Crohn's disease and intestinal tuberculosis: challenging from every angle.

A woman in her 20s with a recent diagnosis of Crohn's disease (CD) affecting the ileocaecal valve was started on adalimumab, after routine tuberculosis (TB) tests were negative. Her abdominal symptoms got worse and she started presenting respiratory distress and fever. Tomography revealed a left pleural effusion, pneumonia and peritonitis with pelvic abscess. The diagnosis of disseminated TB with digestive involvement was suggested and sputum cultures were positive for Mycobacterium tuberculosis Treatment for TB was started and immunosuppressants discontinued, leading to respiratory improvement. Abdominal imaging was repeated, showing worsening signs of multisegmental ileal wall thickening, ileocaecal valve obstruction and a persistent pelvic abscess. She was then submitted to a laparoscopic ileocaecal resection for suspicion of worsening CD. Histopathology showed chronic ileocolitis compatible with CD and ganglionic tuberculosis, revealing the diagnosis of intestinal tuberculosis superimposed in CD. Recovery was uneventful.

Intestinal tuberculosis presented as spindle cell pseudotumor in a HIV-positive case / Tuberculosis intestinal presentada como pseudotumor de células fusiformes en un caso VIH positivo

MSP is a rare and atypical form of benign granulomatous inflammation characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria, which should be differentiated from neoplastic lesions. A 26-year-old Chinese man complained an intermittent and mild right lower abdominal pain for 5 months in May 2022.Histopathology of biopsy samples showed Mycobacterial spindle cell pseudotumor (MSP). The test of Mycobacterium tuberculosis detected by polymerase chain reaction using intestinal tissue slice was negative. The metagenomic next-generation sequencing (BGI-Shenzhen) using formalin-fixation and paraffin-embedded intestine samples confirmed Mycobacterium tuberculosis complex (MTBC).(AU)

Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series.

BACKGROUND: Abdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. METHODS: This was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. RESULTS: A total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. CONCLUSION: Abdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.

A case report of systemic lupus erythematosus and intestinal tuberculosis with lower gastrointestinal bleeding: A treatment approach utilizing parenteral nutrition.

RATIONALE: Limited literatures are available on lower gastrointestinal bleeding in systemic lupus erythematosus (SLE) combined with intestinal tuberculosis. Sharing the treatment experiences of a 26-year-old female patient diagnosed with this complex condition in this report may contribute valuable insights. PATIENT CONCERNS: The patient initially presented with abdominal pain and active gastrointestinal bleeding, leading to admission to the hospital. Over a 2-week period, she experienced persistent bleeding, with daily volumes ranging from 300 mL to 800 mL. DIAGNOSES: Lower gastrointestinal bleeding was diagnosed in this patient with concurrent systemic lupus erythematosus and intestinal tuberculosis. INTERVENTIONS: As her symptoms rapidly progressed, food and water intake had to be completely restricted. The parenteral nutrition was implemented. OUTCOMES: The medical team effectively controlled the bleeding, leading to a notable improvement in the patient's condition. Consequently, she was able to resume oral intake and was discharged from the hospital. LESSONS: This case highlights the significance of using parenteral nutrition in the management of lower gastrointestinal bleeding in patients with concurrent systemic lupus erythematosus and intestinal tuberculosis. Close monitoring and collaborative efforts among healthcare professionals are crucial to achieve successful outcomes in similar cases.

Case report: a case report and literature analysis on intestinal tuberculosis intestinal perforation complicated by umbilical intestinal fistula and bladder ileal fistula.

BACKGROUND: Intestinal tuberculosis is a chronic and specific infection caused by Mycobacterium tuberculosis invading the intestine. Due to the nonspecific clinical presentation, it is stressed that intestinal perforation complicates umbilical intestinal fistula and bladder ileal fistula is very rare and extremely difficult to be diagnosed. It is significant to identify the disease and take urgent intervene in the early stage. CASE PRESENTATION: An 18-month-old boy patient presented with abdominal pain. Abdominal CT suggested abscess formation in the right lower abdomen and pelvis. The patient underwent resection of necrotic and stenotic intestinal segments with the creation of an ileostomy, cystostomy and vesicoureteral fistula repair for the presence of intestinal perforation complicated by vesicoureteral fistula and umbilical enterocutaneous fistula. Histopathology confirmed the intestinal tuberculosis. The patient was discharged successfully after 11 days post anti-tuberculosis treatment. CONCLUSION: Our case report here is a rare case of umbilical intestinal fistula with bladder ileal fistula secondary to intestinal perforation from intestinal tuberculosis. The purpose of this report is to make the surgical community aware of atypical presentations of intestinal tuberculosis. If our peers encounter the similar situation, they can be prepared for corresponding diagnosis and treatment.

Cecal Perforation Following Intraperitoneal Abscess after Anti-tubercular Therapy: A Case Report.

Abdominal tuberculosis is defined as infection of gastrointestinal tract, peritoneum, abdominal solid organs, and/or abdominal lymphatics constituting approximately 12% of extra-pulmonary tuberculosis cases. Intestinal perforation is an acute presentation of abdominal tuberculosis. Intestinal perforation can occur before or at the beginning of anti-tubercular therapy. It is considered to be a paradoxical reaction if it occurs during or after treatment. Intestinal perforation is uncommon but serious and life-threatening as complication-mortality rate secondary to perforation are estimated to be >30%. We present a case of an 18-year-old female who developed cecal perforation following an intraperitoneal abscess after completion of anti-tubercular therapy for intestinal tuberculosis. She was a known case of intestinal tuberculosis. She had undergone pigtail catheterisation for an intraperitoneal abscess and completed 18 months of anti-tubercular therapy after which she developed cecal perforation. A paradoxical response was observed following the completion of anti-tubercular therapy. Early diagnosis and treatment reduce the complications and mortality rates of cecal perforation due to abdominal tuberculosis. Keywords: case reports; cecum; intestinal perforation; tuberculosis.

Intestinal tuberculosis presented as spindle cell pseudotumor in a HIV-positive case.

MSP is a rare and atypical form of benign granulomatous inflammation characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria, which should be differentiated from neoplastic lesions. A 26-year-old Chinese man complained an intermittent and mild right lower abdominal pain for 5 months in May 2022.Histopathology of biopsy samples showed Mycobacterial spindle cell pseudotumor (MSP). The test of Mycobacterium tuberculosis detected by polymerase chain reaction using intestinal tissue slice was negative. The metagenomic next-generation sequencing (BGI-Shenzhen) using formalin-fixation and paraffin-embedded intestine samples confirmed Mycobacterium tuberculosis complex (MTBC).

[Abdominal tuberculosis in children]. / Abdominal'nyi tuberkulez u detei.

OBJECTIVE: To determine the features of diagnosis and clinical course of abdominal tuberculosis in children. MATERIAL AND METHODS: Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens. RESULTS: Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed. CONCLUSION: Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

Gastric tuberculosis presenting as a large gastric ulcer.

While gastrointestinal (GI) tuberculosis (TB) accounts for 1%-3% of all TB cases worldwide, TB of the stomach is extremely rare and accounts for 1%-2% of all GI TB. Little is known about this entity, and most data are obtained from case reports. We report a case of a woman in her 60s who presented with a 2-week history of generalised weakness, fatigue and shivering, with severe loss of appetite on background history of dyspepsia and significant weight loss for the preceding 2 years. Upper endoscopy revealed a large gastric ulcer. Biopsy and histopathology revealed caseating granulomas with numerous acid-fast bacilli detected with Ziehl-Neelsen stain. She was diagnosed with gastric TB. Subsequently, she was also diagnosed with pulmonary, adrenal and colonic involvement.

Concurrent ascending colon adenocarcinoma and ileocecal tuberculosis: A case report.

RATIONALE: Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another. PATIENT CONCERNS: A 59-year-old man visited our clinic with dizziness and anorexia. DIAGNOSIS: Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas. INTERVENTIONS: Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed. OUTCOMES: The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells. LESSONS: In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis.

Esophagomediastinal fistula: a rare case of gastrointestinal tuberculosis.

A 40-year-old male with history of HIV infection was admitted to the hospital with a one-month history of productive cough, vespertine fever, night sweats, loss of appetite and unintentional 10-Kg weight loss. Physical exam was remarkable for cachexia. Blood tests revealed a CD4+ T lymphocyte count of 23 cells/mm3 and HIV viral load of 837,678 copies/ml. Bacilloscopies were positive. Chest computed thomography (CT) showed multiple mediastinal lymph nodes, signs of esophagomediastinal fistula, pericardial effusion and multiple micronodular pulmonary opacities. Endoscopy (EGD) revealed a 10 mm deep ulcer-like lesion in the middle esophagus with pus overflow, but no bubbles were seen. The diagnosis of stage C3 HIV infection with disseminated tuberculosis was made and the patient underwent standard antituberculosis (RIPE) and antiretroviral therapy. Given the mediastinitis risk a percutaneous endoscopic gastrostomy (PEG) tube was placed for nutritional purposes.

Esophageal tuberculosis induced dysphagia: a case report.

BACKGROUND: Patients can present for a wide variety of etiologies for dysphagia, and it is important to consider less common causes once common etiologies have been ruled out. Extrapulmonary Mycobacterium tuberculosis (TB) presentations are rare to see in the western populations due to relative lack of TB exposure and overall less immunocompromised populations, but should be considered for at-risk patients. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB (EPTB). CASE PRESENTATION: This is a case report of a 35-year-old Ethiopian male presenting with dysphagia and retrosternal odynophagia who was found to have infiltration of mediastinal lymphadenopathy into the esophageal wall secondary to TB. This patient underwent an upper endoscopy, which revealed a linear 2 cm full thickness mucosal defect in the middle esophagus concerning for an infiltrative process with full thickness tear. Computed tomography (CT) of the chest demonstrated a subcarinal soft tissue mass that was inseparable from the esophagus. He was referred to thoracic surgery and underwent an exploratory mediastinal dissection. A mediastinoscopy scope was inserted and the mediastinal dissection was made until the subcarinal nodes were identified and removed. Biopsy results showed necrotizing and non-necrotizing granulomas, and acid-fast bacilli (AFB) culture from the surgically removed lymph node showed Mycobacterium TB complex growth. He had no known TB exposures and did not have any TB risk factors. He then followed up in infectious disease clinic and was managed with anti-tuberculosis treatment (ATT) with complete resolution of symptoms. CONCLUSIONS: Our patient was ultimately found to have esophageal TB secondary to mediastinal invasion into the esophageal wall from lymphadenopathy associated with TB. This is an extremely rare presentation in western populations due to diminished exposure rates and overall less immunocompromised populations compared to impoverished countries with increased TB exposure and human immunodeficiency virus (HIV) infection rates. Although TB is not as commonly seen in western populations, it should be considered on the differential for any atypical presentations of GI diseases for patients with clinical or geographic risk factors.