Assuntos
Hidrato de Cloral/efeitos adversos , Diarreia/induzido quimicamente , Hipnóticos e Sedativos/efeitos adversos , Pneumatose Cistoide Intestinal/induzido quimicamente , Idoso , Hidrato de Cloral/administração & dosagem , Diagnóstico Diferencial , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pneumatose Cistoide Intestinal/diagnóstico , Fatores de TempoAssuntos
Colestase Intra-Hepática/diagnóstico , Enterovirus Humano B , Infecções por Enterovirus/diagnóstico , Células Gigantes/patologia , Hepatite Viral Humana/diagnóstico , Cirrose Hepática Biliar/diagnóstico , Adulto , Biópsia , Colestase Intra-Hepática/patologia , Diagnóstico Diferencial , Infecções por Enterovirus/patologia , Hepatite Viral Humana/patologia , Humanos , Fígado/patologia , Cirrose Hepática Biliar/patologia , Testes de Função Hepática , MasculinoRESUMO
HISTORY AND ADMISSION FINDINGS: A 47-year-old Angolan complained of upper abdominal pain, fever, weight loss and night sweats. Abdominal ultrasound performed by his general practitioner showed enlarged lymph nodes at the liver hilum. Physical examination was negative except for slight tenderness over the right upper abdomen. INVESTIGATIONS: A tuberculin skin test was clearly positive. Upper gastrointestinal endoscopy revealed multiple gastric ulcers and the Helicobacter pylori test was positive. The lymph nodes at the liver hilum were needle-aspirated, this showed granulomatous inflammation similar to the biopsies of the ulcers. Eradication of Helicobacter pylori and therapy with proton pump inhibitors were initiated. DIAGNOSIS, TREATMENT AND COURSE: Epigastric pain and the ulcers persisted unchanged. The culture of the lymph node aspirate grew multiresistent Mycobacterium tuberculosis. With adequate tuberculostatic therapy the patient improved rapidly and the further course was without any complications. CONCLUSION: Tuberculosis should be included in the differential diagnosis in non-healing ulcers of the gastrointestinal tract, especially in immigrants from endemic areas.