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Minani JB, Bisimwa W, Cikomola Gulimwentuga F, Bedha A, Maheshe Balemba G, Mateso Mbale GQ, Lupande Mwenebitu D, Mulumeoderhwa Kahasha P, Baguma M, Mwene-Batu P, Katoto PD, Shindano TA. Atypical tuberculous peritonitis presenting as a peritoneal pseudocyst in an immunocompetent adult: insights from a case and literature review. BMC Infect Dis 2024; 24:1077. [PMID: 39350023 PMCID: PMC11441176 DOI: 10.1186/s12879-024-09955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Tuberculous peritonitis often presents with nonspecific symptoms that can lead to diagnostic challenges, particularly when manifesting as peritoneal pseudocysts. This study highlights the clinical complexity and diagnostic approach of tuberculous peritonitis presented as a pseudocyst in an immunocompetent adult, an atypical scenario that is rarely documented. CASE PRESENTATION We report a detailed case of a 41-year-old man presenting with abdominal distension, pain, and significant weight loss over four months. Abdominal CT showed a peritoneal pseudocyst, initially misdiagnosed due to its resemblance to more common abdominal pathologies. The diagnosis of tuberculous peritonitis was confirmed through histopathological analysis. Additionally, a systematic literature review was conducted to identify and analyse similar cases, focusing on clinical presentations, diagnostic methods, and patient outcomes. Our patient exhibited classic symptoms of abdominal TB but was unique due to the absence of prior ventriculoperitoneal shunting, a common factor in similar cases. Our literature review found that such presentations typically result in diagnostic delays averaging five months, complicating patient management and outcomes. This review also underscores the importance of considering tuberculosis in the differential diagnosis of peritoneal pseudocysts, particularly in TB-endemic regions. CONCLUSION This case and review emphasize the need for high clinical suspicion and prompt investigation of tuberculosis in patients presenting with atypical abdominal symptoms and pseudocysts. Improved diagnostic strategies, including early use of imaging and pathological evaluations, are essential for timely diagnosis and management, thereby improving patient outcomes in suspected cases of extrapulmonary tuberculosis.
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Affiliation(s)
- Jimmy Balibanga Minani
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo.
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo.
| | - Wani Bisimwa
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Surgery, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Fabrice Cikomola Gulimwentuga
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Surgery, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Tropical Diseases and Global Health, Department of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Aline Bedha
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Ghislain Maheshe Balemba
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Radiology, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Guy-Quesney Mateso Mbale
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Intensive Care Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - David Lupande Mwenebitu
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Tropical Diseases and Global Health, Department of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Laboratory, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Pierrot Mulumeoderhwa Kahasha
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Department of Pathology, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Marius Baguma
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Tropical Diseases and Global Health, Department of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Pacifique Mwene-Batu
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
| | - Patrick Dmc Katoto
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Tropical Diseases and Global Health, Department of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Evidence Based Medicine, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tony Akilimali Shindano
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, South Kivu, Democratic Republic of the Congo
- Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
- Centre for Tropical Diseases and Global Health, Department of Medicine, Université Catholique de Bukavu (UCB), Bukavu, South Kivu, Democratic Republic of the Congo
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Velikova T, Aleksandrova A. Interferon-gamma release assays as a tool for differential diagnosis of gastrointestinal tuberculosis. World J Clin Cases 2024; 12:6015-6019. [PMID: 39328852 PMCID: PMC11326105 DOI: 10.12998/wjcc.v12.i27.6015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/12/2024] [Accepted: 06/07/2024] [Indexed: 07/29/2024] Open
Abstract
In this editorial, we comment on an article published in a recent issue of the World Journal of Clinical Cases. There is a pressing need for reliable tools for diagnosing tuberculosis (TB) of the gastrointestinal tract. Despite advancements in the diagnosis and treatment, TB remains a global health challenge. Ali et al demonstrated that TB may mimic gastrointestinal conditions, such as gastric outlet obstruction, causing a delay in the diagnosis. Furthermore, the latter complication is frequently observed during infections, including Helicobacter pylori, and rarely is related to TB, as in the presented case. In line with this, we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract. Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University Street Kliment Ohridski, Sofia 1407, Bulgaria
| | - Anita Aleksandrova
- Department of Immunology, Medical-diagnostic laboratory Ramus, Simitli 6000, Bulgaria
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Chatterjee A, Yadav AI, Sekar A, Singh H, Dutta U, Sharma V. Letter: Extreme diagnostic delay due to misdiagnosis of gastrointestinal tuberculosis later diagnosed as postoperative Crohn's disease. Aliment Pharmacol Ther 2024; 60:537-539. [PMID: 39039832 DOI: 10.1111/apt.18107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
LINKED CONTENTThis article is linked to Jayasooriya et al paper. To view this article, visit https://doi.org/10.1111/apt.17370.
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Affiliation(s)
- Abhirup Chatterjee
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Ishan Yadav
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Sekar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of GI Surgery, HPB and Liver Transplantation, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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4
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Murakami D, Amano Y, Arai M. Image-enhanced endoscopy in intestinal tuberculosis. Arab J Gastroenterol 2024; 25:318-319. [PMID: 39039003 DOI: 10.1016/j.ajg.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/10/2023] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Daisuke Murakami
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan; Department of Gastroenterology and Endoscopy, New Tokyo Hospital, Chiba, Japan.
| | - Yuji Amano
- Department of Gastroenterology and Endoscopy, New Tokyo Hospital, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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5
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Bhowmick M, Sharma V. Cryptogenic multifocal ulcerous stenosing enteritis: A ray of light on the umbra of the dark continent. Indian J Gastroenterol 2024:10.1007/s12664-024-01645-8. [PMID: 39023741 DOI: 10.1007/s12664-024-01645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Mithu Bhowmick
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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6
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Patel MV, Patel DM, Patel DK, Patel MM, Patel LB, Patel VM. Inflammatory bowel diseases presenting as pyrexia of unknown origin without bowel symptoms: A case series. Indian J Gastroenterol 2024:10.1007/s12664-024-01620-3. [PMID: 38896351 DOI: 10.1007/s12664-024-01620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Mukundkumar V Patel
- Department of Medicine, Ananya College of Medicine and Research, Kalol, 382 721, India.
| | | | - Dhara K Patel
- Department of Pathology, GCS Medical College and Research Centre, Ahmedabad, 380 025, India
| | - Maitri M Patel
- GCS Medical College and Research Centre, Ahmedabad, 380 025, India
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Correia FP, Figueiredo LM, Lourenço LC, Santos S, Manso RT, Horta D. Primary Gastric Tuberculosis in an Immunocompetent Patient: The Truth Lying beneath the Surface. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:191-195. [PMID: 38836125 PMCID: PMC11149989 DOI: 10.1159/000531380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2024]
Abstract
Gastrointestinal tuberculosis is an uncommon entity, in which clinical presentation can be widely variable, from mild and nonspecific symptoms to an acute abdomen and gastrointestinal bleeding. Gastric involvement by Mycobacterium tuberculosis is rare, especially when it occurs without other recognized infectious foci - primary gastric tuberculosis - with only a few reported cases. Endoscopic findings can be very heterogeneous, from areas of hyperemia to pseudotumor lesions. We present a case of primary gastric tuberculosis in an immunocompetent patient, in which the absence of an epidemiological context and nonspecific endoscopic findings led to a delay in the diagnosis. Bite-on-bite biopsies proved to be essential, allowing to obtain samples from deeper layers of the submucosa where M. tuberculosis was identified. This case aimed to increase awareness for this entity, especially in endemic countries or regions with a high prevalence of tuberculosis since the diagnosis is based mainly on a high index of suspicion.
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Affiliation(s)
- Fábio Pereira Correia
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Luís Carvalho Lourenço
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Gastroenterology Center, Cuf Tejo/ NOVA Medical School, Lisbon, Portugal
| | - Sofia Santos
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Theias Manso
- Pathological Anatomy Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - David Horta
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Gastroenterology Center, Cuf Tejo/ NOVA Medical School, Lisbon, Portugal
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8
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Pathak P, Sharma V. Stricturing Crohn's disease-Gastrointestinal tuberculosis as an important differential. Indian J Gastroenterol 2024:10.1007/s12664-024-01616-z. [PMID: 38814493 DOI: 10.1007/s12664-024-01616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Parna Pathak
- Kasturba Medical College, Manipal, 576 104, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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9
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Arevalo F, Rayme S, Ramírez R, Rolando R, Fustamante J, Monteghirfo M, Chavez R, Monge E. Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population. BMC Gastroenterol 2024; 24:166. [PMID: 38755577 PMCID: PMC11097500 DOI: 10.1186/s12876-024-03235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION The diagnosis of intestinal tuberculosis is challenging even nowadays. This study aims to report the positivity rates of new diagnostic methods such as immunohistochemistry and Real-Time Polymerase Chain Reaction in patients with intestinal tuberculosis, as well as describe the pathological and endoscopic features of intestinal tuberculosis in our population. METHODS This was a retrospective observational study conducted in patients diagnosed with intestinal tuberculosis, between 2010 to 2023 from the Hospital Nacional Daniel Alcides Carrion and a Private Pathology Center, both located in Peru. Clinical data was obtained, histologic features were independently re-evaluated by three pathologists; and immunohistochemistry and real-time Polymerase Chain Reaction evaluation were performed. The 33 patients with intestinal tuberculosis who fulfilled the inclusion criteria were recruited. RESULTS Immunohistochemistry was positive in 90.9% of cases, while real-time Polymerase Chain Reaction was positive in 38.7%. The ileocecal region was the most affected area (33.3%), and the most frequent endoscopic appearance was an ulcer (63.6%). Most of the granulomas were composed solely of epithelioid histiocytes (75.8%). Crypt architectural disarray was the second most frequent histologic finding (78.8%) after granulomas, but most of them were mild. CONCLUSION Since immunohistochemistry does not require an intact cell wall, it demonstrates higher sensitivity compared to Ziehl-Neelsen staining. Therefore, it could be helpful for the diagnosis of paucibacillary tuberculosis.
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Affiliation(s)
- Fernando Arevalo
- Pathology Department, Hospital Nacional Daniel A. Carrión, Callao, Lima, Perú.
- Histodiagnóstico Gastrointestinal Private Pathology Center, Lima, Perú.
- Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Soledad Rayme
- Pathology Department, Hospital Nacional Daniel A. Carrión, Callao, Lima, Perú
- Histodiagnóstico Gastrointestinal Private Pathology Center, Lima, Perú
| | - Rocío Ramírez
- Pathology Department, Hospital Nacional Daniel A. Carrión, Callao, Lima, Perú
- Histodiagnóstico Gastrointestinal Private Pathology Center, Lima, Perú
| | - Romy Rolando
- Instituto de Medicina Legal y Ciencias Forenses - Perú, Lima, Perú
- Histodiagnóstico Gastrointestinal Private Pathology Center, Lima, Perú
| | - Jaime Fustamante
- Gastroenterology Department, Hospital Nacional Daniel A., Carrión, Lima, Perú
| | - Mario Monteghirfo
- Departamento de Ciencias Dinámicas, Facultad de Medicina, Instituto de Investigacion de Bioquímica y Nutrición Alberto Guzmán Barrón, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Rocio Chavez
- Gastroenterology Department, Hospital Nacional Adolfo Guevara Velasco EsSalud, Cuzco, Perú
- Universidad San Antonio Abad, Cuzco, Perú
- Instituto de Gastroenterologia del Sur, Cuzco, Perú
| | - Eduardo Monge
- Gastroenterology Department, Hospital Nacional Daniel A., Carrión, Lima, Perú
- Universidad Nacional Mayor de San Marcos, Lima, Perú
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Sachan A, Kakadiya R, Mishra S, Kumar-M P, Jena A, Gupta P, Sebastian S, Deepak P, Sharma V. Artificial intelligence for discrimination of Crohn's disease and gastrointestinal tuberculosis: A systematic review. J Gastroenterol Hepatol 2024; 39:422-430. [PMID: 38058246 DOI: 10.1111/jgh.16430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Discrimination of gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) is difficult. Use of artificial intelligence (AI)-based technologies may help in discriminating these two entities. METHODS We conducted a systematic review on the use of AI for discrimination of GITB and CD. Electronic databases (PubMed and Embase) were searched on June 6, 2022, to identify relevant studies. We included any study reporting the use of clinical, endoscopic, and radiological information (textual or images) to discriminate GITB and CD using any AI technique. Quality of studies was assessed with MI-CLAIM checklist. RESULTS Out of 27 identified results, a total of 9 studies were included. All studies used retrospective databases. There were five studies of only endoscopy-based AI, one of radiology-based AI, and three of multiparameter-based AI. The AI models performed fairly well with high accuracy ranging from 69.6-100%. Text-based convolutional neural network was used in three studies and Classification and regression tree analysis used in two studies. Interestingly, irrespective of the AI method used, the performance of discriminating GITB and CD did not match in discriminating from other diseases (in studies where a third disease was also considered). CONCLUSION The use of AI in differentiating GITB and CD seem to have acceptable accuracy but there were no direct comparisons with traditional multiparameter models. The use of multiple parameter-based AI models have the potential for further exploration in search of an ideal tool and improve on the accuracy of traditional models.
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Affiliation(s)
- Anurag Sachan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rinkalben Kakadiya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubhra Mishra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Huang G, Wu KK, Li XN, Kuai JH, Zhang AJ. Intestinal tuberculosis with small bowel stricture and hemorrhage as the predominant manifestation: Three case reports. World J Gastrointest Surg 2024; 16:248-256. [PMID: 38328313 PMCID: PMC10845280 DOI: 10.4240/wjgs.v16.i1.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Intestinal tuberculosis is a chronic disease caused by Mycobacterium tuberculosis that mainly affects the ileum and cecum. Small bowel tuberculosis, characterized by predominant involvement of the small intestine, is an extremely rare condition with highly atypical clinical presentations, making diagnosis even more challenging. CASE SUMMARY We report three cases of small intestinal tuberculosis, two of the patients presented primarily with abdominal pain, and one presented with gastrointestinal bleeding. All patients underwent blood tests and imaging examinations. Small bowel endoscopy (SBE) revealed that the main lesions in these patients were intestinal stenosis or gastrointestinal bleeding caused by small intestinal ulcers. One patient ultimately underwent surgical treatment. Following a complex diagnostic process and comprehensive analysis, all patients were confirmed to have small intestinal tuberculosis and received standard antituberculosis treatment, leading to an improvement in their condition. CONCLUSION Patients with SBTs present with nonspecific symptoms such as abdominal pain, weight loss, and occasional gastrointestinal bleeding. Accurate diagnosis requires a thorough evaluation of clinical symptoms and various tests to avoid misdiagnosis and complications.
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Affiliation(s)
- Gang Huang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Kang-Kang Wu
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Xiao-Na Li
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Jing-Hua Kuai
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Ai-Jun Zhang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
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12
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Hu Q, Zheng SH, Liu W. Tuberculous peritonitis. Indian J Gastroenterol 2024:10.1007/s12664-023-01517-7. [PMID: 38225484 DOI: 10.1007/s12664-023-01517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Qian Hu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang, 443000, China
- Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Shi-Hua Zheng
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang, 443000, China
- Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Wei Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
- Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang, 443000, China.
- Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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Maulahela H, Annisa NG, Syam AF, Stephanie M, Dwina Billianti Y. Tuberculosis of the Stomach Mimicking Gastric Submucosal Tumor: Diagnosis by Endoscopic Ultrasound. Case Rep Gastroenterol 2024; 18:379-385. [PMID: 39144822 PMCID: PMC11324280 DOI: 10.1159/000540293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 06/19/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Gastrointestinal tuberculosis (TB), specifically gastric TB, is a rare form of extrapulmonary TB. Diagnosis proves challenging with nonspecific signs and symptoms. In this case report, a 22-year-old male came in with complaints of recurrent hematemesis and melena. Case Presentation We found a submucosal mass with ulceration in the stomach cardia on esophagoduodenoscopy (EGD). The endoscopic ultrasound (EUS) finding was a hypoechoic submucosal lesion with a clear margin; specimens were taken using fine needle aspiration (FNA) for further histopathological examination. The result indicated granuloma of Mycobacterium Tuberculosis in pathology, suggesting that the diagnosis was gastric TB. The patient was then treated with antitubercular therapy regimen for 9 months. The previously documented mass in the stomach cardia was no longer visible on the follow-up endoscopy examination, and the patient was considered cured. Conclusion This case shows that gastric tuberculosis should be considered in patients with gastrointestinal symptoms, especially those living in TB endemic regions. Endoscopic examinations, such as EGD and EUS, may aid in the diagnosis of gastric tuberculosis.
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Affiliation(s)
- Hasan Maulahela
- Division of Gastroenterology, Department of Internal Medicine, Pancreatobilliary and Digestive Endoscopy, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Central National Hospital, Jakarta, Indonesia
| | - Nagita Gianty Annisa
- Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Central National Hospital, Jakarta, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Pancreatobilliary and Digestive Endoscopy, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Central National Hospital, Jakarta, Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Central National Hospital, Jakarta, Indonesia
| | - Yayi Dwina Billianti
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Central National Hospital, Jakarta, Indonesia
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14
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Sharma V. Enduring Dilemmas in Gastroenterology. Diagnostics (Basel) 2023; 14:65. [PMID: 38201374 PMCID: PMC10802899 DOI: 10.3390/diagnostics14010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Making a correct diagnosis is the first, and most important, step in the therapeutic journey of a disease [...].
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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15
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Jha DK, Choudhury A, Sharma V. Digestive Tract Tuberculosis Guidelines-The Missing Link. J Clin Gastroenterol 2023; 57:1070. [PMID: 37646540 DOI: 10.1097/mcg.0000000000001912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Daya K Jha
- Department of Gastroenterology, Army Hospital R and R, New Delhi, India
| | - Arup Choudhury
- Department of Medicine, Nagaon Medical College Hospital, Assam, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Jha DK, Gupta P, Neelam PB, Kumar R, Krishnaraju VS, Rohilla M, Prasad AS, Dutta U, Sharma V. Clinical and Radiological Parameters to Discriminate Tuberculous Peritonitis and Peritoneal Carcinomatosis. Diagnostics (Basel) 2023; 13:3206. [PMID: 37892027 PMCID: PMC10605989 DOI: 10.3390/diagnostics13203206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
It is challenging to differentiate between tuberculous peritonitis and peritoneal carcinomatosis due to their insidious nature and intersecting symptoms. Computed tomography (CT) is the modality of choice in evaluating diffuse peritoneal disease. We conducted an ambispective analysis of patients suspected as having tuberculous peritonitis or peritoneal tuberculosis between Jan 2020 to Dec 2021. The study aimed to identify the clinical and radiological features differentiating the two entities. We included 44 cases of tuberculous peritonitis and 45 cases of peritoneal carcinomatosis, with a median age of 31.5 (23.5-40) and 52 (46-61) years, respectively (p ≤ 0.001). Fever, past history of tuberculosis, and loss of weight were significantly associated with tuberculous peritonitis (p ≤ 0.001, p = 0.038 and p = 0.001). Pain in the abdomen and history of malignancy were significantly associated with peritoneal carcinomatosis (p = 0.038 and p ≤ 0.001). Ascites was the most common radiological finding. Loculated ascites, splenomegaly and conglomeration of lymph nodes predicted tuberculous peritonitis significantly (p ≤ 0.001, p = 0.010, p = 0.038). Focal liver lesion(s) and nodular omental involvement were significantly associated with peritoneal carcinomatosis (p = 0.011, p = 0.029). The use of clinical features in conjunction with radiological findings provide better diagnostic yields because of overlapping imaging findings.
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Affiliation(s)
- Daya K. Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (D.K.J.); (P.B.N.); (U.D.)
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Pardhu B. Neelam
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (D.K.J.); (P.B.N.); (U.D.)
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (R.K.); (V.S.K.)
| | - Venkata S. Krishnaraju
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (R.K.); (V.S.K.)
| | - Manish Rohilla
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Ajay S. Prasad
- Department of Gastroenterology, Army Hospital Research and Referral, New Delhi 110010, India;
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (D.K.J.); (P.B.N.); (U.D.)
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; (D.K.J.); (P.B.N.); (U.D.)
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17
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Choudhury A, Dhillon J, Sekar A, Gupta P, Singh H, Sharma V. Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review. BMC Gastroenterol 2023; 23:246. [PMID: 37468869 DOI: 10.1186/s12876-023-02887-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Gastrointestinal Tuberculosis (GITB) and Crohn's disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course.
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Affiliation(s)
| | | | - Aravind Sekar
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Harjeet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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18
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KC P, Bhattarai M, Adhikari S, Parajuli P, Bhandari S, Bhattarai HB, Sharma NK, Karki S, Acharya S, Basnet B. Intestinal tuberculosis can masquerade as Crohn's disease: A teachable moment. SAGE Open Med Case Rep 2023; 11:2050313X231184342. [PMID: 37425137 PMCID: PMC10328157 DOI: 10.1177/2050313x231184342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Intestinal tuberculosis and Crohn's disease are chronic granulomatous diseases with similar clinical presentations and can mimic one another. Their treatment modalities are completely different; however, sometimes it is challenging to differentiate them. We report a case of a 51-year-old female presenting with abdominal pain and on-and-off diarrhea for 4 years with weight loss. Clinical symptoms along with multiple aphthous ulcers in the terminal ileum and negative tuberculin test favored the diagnosis of Crohn's disease. The patient did not respond to steroids. A repeat colonoscopy with acid-fast bacilli stain showed Mycobacterium tuberculosis. This case highlights that acid-fast bacilli culture and tuberculosis polymerase chain reaction to confirm or rule out the diagnosis of intestinal tuberculosis in all patients suspected of Crohn's disease.
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Affiliation(s)
- Pooja KC
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Subodh Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prakriti Parajuli
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | | | | | - Shailendra Karki
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Suryakiran Acharya
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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19
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Mantilla JC, Chaves JJ, Africano-Lopez F, Blanco-Barrera N, Mantilla MJ. Gastrointestinal tuberculosis: An autopsy-based study. INFECTIOUS MEDICINE 2023; 2:122-127. [PMID: 38077832 PMCID: PMC10699657 DOI: 10.1016/j.imj.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2024]
Abstract
BACKGROUND Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide. Gastrointestinal tuberculosis is an unusual presentation. It is defined as the involvement of any segment of the digestive tract, associated viscera, and peritoneum. The study's main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia. METHODS This is a retrospective and descriptive study of autopsy reports. A total of 4,500 autopsies were performed between January 2004 and December 2020. The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization. RESULTS Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study. Most of the patients were male (n = 35, 72.9%) with a median age of 40.5 years old. Human immunodeficiency virus infection history was reported in 28 cases (58.33%). The most affected gastrointestinal tract site was the terminal ileum. Ulcers and thickened epithelium were common autopsies macroscopic findings. Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis. CONCLUSIONS Gastrointestinal tuberculosis is a disease of great importance, being its diagnosis a clinical challenge. Underdiagnosis can be reported in a high percentage of cases, so autopsy diagnosis can help reveal more accurate data about this condition.
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Affiliation(s)
- Julio Cesar Mantilla
- Department of Pathology, Universidad Industrial de Santander, Bucaramanga 680002, Colombia
- Department of Pathology, Hospital Universitario de Santander, Bucaramanga 680002, Colombia
| | - Juan José Chaves
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá 111411, Colombia
- Department of Gastroenterology, Gastrocenter and Medical Specialities, Ipiales 524061, Colombia
| | - Ferney Africano-Lopez
- Department of Gastroenterology, Universidad Militar Nueva Granada, Bogotá 250240, Colombia
| | - Néstor Blanco-Barrera
- Department of Gastroenterology, Universidad Militar Nueva Granada, Bogotá 250240, Colombia
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