Tuberculosis of the rectum in a patient with acquired immune deficiency syndrome. Report of a case

Tuberculosis of the rectum is a rare disease. A patient with a miliary pattern of pulmonary tuberculosis had a rectal lesion which proved to be tuberculosis. The patient subsequently developed several opportunistic infections characteristic of acquired immune deficiency syndrome. The clinical, endoscopic, radiologic, and histologic findings of this treatable lesion are presented.

Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS

Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.

A 42-year-old king with a cavitary pulmonary lesion and intestinal perforation

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Radiographic manifestations of gastrointestinal tuberculosis

Barium studies of a gastrointestinal tract and chest radiographs of 109 patients with gastrointestinal tuberculosis were investigated. The type and site of the tuberculous lesions in the bowel, as well as its association with pulmonary tuberculosis and surgical complications, were reviewed. The ileocecal region is the portion of the gastrointestinal tract most frequently involved. The ulcerohypertrophic type of tuberculous lesion was the most common. Thirty-two percent of the patients had a normal chest radiograph. Nineteen patients had a significant surgical complication. Fistulous tracts and intestinal perforation are rare. The radiographic differential diagnosis with regional enteritis and other forms of inflammatory bowel disease is discussed.

Ten years' survey of dialysis-associated tuberculosis

Tuberculosis associated with dialysis was studied at the Renal Unit of the Tokyo Medical and Dental University and Yokosuka Mutual Aid Hospital Kidney Center, in both of which the treatments of chronic renal failure are the same. There are 12 tuberculosis patients out of 367 patients on maintenance hemodialysis from January 1967 to December 1976, an incidence of 3.3%. This was 6-16 times greater than that in the general population of this country according to yearly statistics. The characteristics of dialysis-associated tuberculosis include a high incidence of miliary tuberculosis, especially in aged patients and difficulty in establishing the diagnosis before death. Clinical features which are helpful in the early diagnosis are intermittent high fever of unknown origin, weight loss, anorexia, abnormalities of the central nervous system, erythrocyte sedimentation rate over 100 mm/h, leukocytosis and high value of the C-reactive protein. With the increasing number of dialysis patients, an increase of dialysis-associated tuberculosis is expected and this will be one of the major problems of dialysis patients in future.

[Tuberculosis and caustic eso-gastric burns. Critical reflections on one case]

The diagnostic problems which may be raised during caustic oesophago-gastric burns and concommittent tuberculosis, of which the symptoms may be masked by the richness of the initial clinical picture are discussed here. The authors emphasise the necessity of prophylactic anti-tuberculous treatment, before any surgery when there is any suggestion of tuberculosis even siabilised.

Tuberculous ileo-colitis in Ibadan: a clinicoradiological review

Twenty cases of tuberculous ileo-colitis with radiographic changes seen in the University College Hospital, Ibadan, Nigeria, are reviewed and the clinical features and radiographic patterns examined. The intestinal lesions in all cases were secondary to healed and active pulmonary tuberculosis. Although the ileo-caecal region is the commonest site of involvement, lesions also occurred in the distal part of the colon and the entire colon was sometimes involved. Rare occurrences, such as the diverticular type, enterolithiasis, tuberculosis presenting as intussusception and as an appendicular mass, are also reported. Four principal radiological types of colonic change emerged from the study, namely, the hyperplastic, the ulcerative, the mixed ulcero-hyperplastic, and the carcinoma-like types. The salient features in the differential diagnosis of ileo-colonic lesions in a tropical setting are discussed.