1
|
Das A, Mead P, Mala HR. Abdominal tuberculosis masquerading as ovarian carcinoma in a Caucasian woman: a diagnostic challenge. BMJ Case Rep 2022; 15:e244015. [PMID: 35217547 PMCID: PMC8883184 DOI: 10.1136/bcr-2021-244015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 37-year-old Caucasian woman with abdominal distension and loss of weight. She was initially presumed to be a case of ovarian malignancy due to an elevated serum cancer antigen 125 (CA 125) level and imaging of abdomen and pelvis that showed ascites and bulky ovaries. However, histological examination of biopsy later revealed it to be a case of abdominal tuberculosis (AbT). Ascitic fluid was also found to be positive for Mycobacterium tuberculosis by whole genome sequencing. The patient was started on antituberculosis treatment following which she showed a significant improvement in her symptoms.
Collapse
Affiliation(s)
- Ananya Das
- Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Paul Mead
- Nephrology, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Hilal Razvi Mala
- General Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
| |
Collapse
|
2
|
Saxena D, Duncan RA, Faust RR, Campagna A. Abdominal cyst of unclear aetiology: gastrointestinal stromal tumour or reactivation of abdominal tuberculosis. BMJ Case Rep 2022; 15:15/1/e245767. [PMID: 34992056 PMCID: PMC8739064 DOI: 10.1136/bcr-2021-245767] [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] [Indexed: 11/27/2022] Open
Abstract
Differential diagnosis of a new abdominal mass is broad and includes infection, malignancy and other inflammatory processes. Definitive diagnosis may be challenging without invasive biopsy, as history, physical exam and imaging may be non-specific. A 69-year-old man with a history of abdominal tuberculosis presented with a new painful abdominal cyst consistent with reactivation of tuberculosis versus new malignancy. Investigations revealed 4+ acid-fast bacilli from the aspirate suggestive of tuberculosis, but no improvement was noted on antituberculous therapy. Core needle biopsy noted c-KIT-positive spindle cells, diagnostic for a gastrointestinal stromal tumour, while cultures grew non-tuberculous mycobacteria.
Collapse
Affiliation(s)
- Damini Saxena
- General Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Robert A Duncan
- Infectious Diseases, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Robert R Faust
- General Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Anthony Campagna
- Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
3
|
Caraux-Paz P, Diamantis S, de Wazières B, Gallien S. Tuberculosis in the Elderly. J Clin Med 2021; 10:jcm10245888. [PMID: 34945187 PMCID: PMC8703289 DOI: 10.3390/jcm10245888] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022] Open
Abstract
The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.
Collapse
Affiliation(s)
- Pauline Caraux-Paz
- Service de Maladies Infectieuses et Tropicales, Hôpital Intercommunal de Villeneuve-Saint-Georges, 94190 Villeneuve-Saint-Georges, France
- Correspondence: ; Tel.: +33-1-4386-2162; Fax: +33-1-4386-2309
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Hôpital de Melun, 77000 Melun, France;
- Unité de Recherche DYNAMIC, Université Paris-Est Créteil, 94000 Créteil, France;
| | | | - Sébastien Gallien
- Unité de Recherche DYNAMIC, Université Paris-Est Créteil, 94000 Créteil, France;
- Service de Maladies Infectieuses, CHU Mondor—APHP, 94000 Créteil, France
| |
Collapse
|
4
|
Mousa H, Abdel-Kader S, Abu-Zidan FM. Management of abdominal tuberculosis in a community-based hospital in a high-income developing country. World J Emerg Surg 2021; 16:25. [PMID: 34039395 PMCID: PMC8153524 DOI: 10.1186/s13017-021-00370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.
Collapse
Affiliation(s)
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE.
| |
Collapse
|
5
|
Rojas CL, Polanco EC, Vivar MC, Aguayo WG, Molina GA, Gutierrez BM, Cobo MM. Abdominal tuberculosis in Ecuador, a problem that is still not solved. J Clin Tuberc Other Mycobact Dis 2020; 20:100172. [PMID: 32637658 PMCID: PMC7330150 DOI: 10.1016/j.jctube.2020.100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) in the gastrointestinal tract or peritoneum is an uncommon condition in clinical practice. Its rarity, combined with its nonspecific presentations, makes this kind of extrapulmonary tuberculosis difficult to diagnose as it can mimic other inflammatory or malignant conditions. Delays in treatment and frequent misdiagnosis can lead to hazardous complications. In countries like Ecuador where the disease is endemic, TB should always be considered in the differential diagnosis of a patients who present with nonspecific abdominal symptoms. In these scenarios, laparoscopy can be an invaluable tool when used with sufficiently high clinical awareness and adequate training. Case presentation We present the case of a 37-year-old female patient from Ecuador with a 1-year history of abdominal pain, nausea, intermittent vomits, night sweats, and weight loss. After clinical evaluation and a laparoscopic intervention, abdominal TB was detected and promptly treated. Antituberculosis chemotherapy was initiated, and the patient successfully recovered. Conclusions High clinical awareness is imperative when approaching abdominal TB due to its wide spectrum of clinical symptoms and its rarity. Early detection and prompt treatment are critical to minimize the possibility of hazardous complications.
Collapse
Affiliation(s)
| | | | - Maria Cecilia Vivar
- Department of Pathology, Hospital General San Francisco de Quito, Quito, Ecuador
| | | | | | - Bernardo M Gutierrez
- Universidad San Francisco de Quito, USFQ, College of Biological and Environmental Sciences, Quito, Ecuador
| | - Maria M Cobo
- Universidad San Francisco de Quito, USFQ, College of Biological and Environmental Sciences, Quito, Ecuador
| |
Collapse
|
6
|
Gastrointestinal Bleeding in a Patient With Gastric Lymphoma, Tuberculosis Enteritis, and Cytomegalovirus Enteritis. ACG Case Rep J 2020; 7:e00317. [PMID: 32309509 PMCID: PMC7145173 DOI: 10.14309/crj.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
Abstract
Bleeding from the small bowel can be challenging to identify by endoscopic or radiographic evaluation. We present the case of a patient with incompletely treated latent tuberculosis and medical history of T-cell lymphoma who developed gastrointestinal bleeding because of concurrent Burkitt lymphoma, tuberculosis enteritis, and cytomegalovirus enteritis. The interplay of these 3 diagnoses is discussed.
Collapse
|
7
|
Mbengue A, Ndiaye AR, Amar NI, Diallo M, Diack A, Ndao MD, Diop M, Fall A, Diouf CT, Soko TO, Diakhate IC. Ultrasonography of peritoneal tuberculosis. J Ultrason 2019; 19:98-104. [PMID: 31355580 PMCID: PMC6750313 DOI: 10.15557/jou.2019.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose The objective of this work was to describe different presentations of peritoneal tuberculosis on ultrasound. Materials and methods This was a retrospective study conducted between 2008 and 2016 at the Main Hospital in Dakar, and including 38 cases of peritoneal tuberculosis. The tests were performed on Philips Envisor and Hitachi Preirus with 10 and 12 MHz linear transducers. The mean age was 26 years and the sex ratio was 0.8. The diagnosis of peritoneal tuberculosis was based on histological evidence (17 cases), isolation of BK from sputum (5 cases), positive adenosine deaminase in ascites fluid (4 cases) or a favorable clinical course after trial antituberculosis treatment (4 cases). The structures studied were the parietal peritoneum, the mesentery, the large omentum, as well as the characteristics of ascites, and extra-peritoneal lesions. Results Parietal peritoneal involvement was found in 89.4% of patients, including regular diffuse hypoechoic thickening in 70.5% and nodular thickening in 11.7%. Ascites was present in 84.2% of patients. The great omentum showed anomalies in 73.6% of cases in relation to 3 aspects: trilamellar thickening made up of a thick, hyperechoic central layer surrounded by 2 thin peripheral hypoechoic layers in 46.4% of cases; a single-layer hyperechoic thickening in 21.4% of cases; heterogeneous hyperechogenic thickening with hypoechoic nodules in 32.1% of cases. Mesentery abnormalities were noted in 63.1% of patients with hypoechoic thickening. Conclusion Ultrasound with the advantage of safety and accessibility is a reliable technique for the diagnosis of peritoneal tuberculosis. In some cases, it allows for a guided percutaneous biopsy to avoid the use of laparoscopy.
Collapse
Affiliation(s)
- Ababacar Mbengue
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | | | - Ndeye Isseu Amar
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Moustapha Diallo
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Aminata Diack
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Mame Diarra Ndao
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Massamba Diop
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Amath Fall
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | | | - Thierno Omar Soko
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | | |
Collapse
|
8
|
Khan RA, Wahab S, Ghani I. Does diverting ileostomy improve the outcome in children with tuberculous small bowel obstruction requiring surgical intervention? Pediatr Surg Int 2017; 33:1215-1219. [PMID: 28956144 DOI: 10.1007/s00383-017-4169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Abdominal tuberculosis is fairly common in children. The most common clinical presentation is bowel obstruction. Depending upon the presentation, the intestinal obstruction can be either managed conservatively or by operative intervention. There are various options in patients who undergo operative treatment. This study was undertaken to analyze the results of operative intervention with and without ileostomy. MATERIALS AND METHODS This is a retrospective study carried out over a period of 10 years on 32 children who were operated for small bowel obstruction due to abdominal tuberculosis. The patients were divided into two groups (A: with ileostomy and B: without ileostomy). The relevant data and the defined outcome measures were statistically analyzed. RESULTS A total of 32 children with tuberculous bowel obstruction requiring surgical intervention were studied. The patient of group A had mean duration of postoperative ileus for 2.55 days, restoration of enteral feeding within mean period of 3.55 days and had a primary hospital stay for a mean period of 9.0 days. These outcomes when compared with group B patients were statistically significant. CONCLUSION In children with bowel obstruction due to tuberculosis, diverting ileostomy decreases the morbidity by allowing early return of enteral motility, early institution of feeding and first-line ATT and decreasing the primary hospital stay.
Collapse
Affiliation(s)
- Rizwan Ahmad Khan
- Department of Pediatric Surgery, J. N. Medical College, AMU, Aligarh, UP, India
| | - Shagufta Wahab
- Department of Radiodiagnosis, J. N. Medical College, AMU, Aligarh, UP, India.
| | - Imran Ghani
- Department of Pediatric Surgery, J. N. Medical College, AMU, Aligarh, UP, India
| |
Collapse
|
9
|
Weledji EP, Pokam BT. Abdominal tuberculosis: Is there a role for surgery? World J Gastrointest Surg 2017; 9:174-181. [PMID: 28932351 PMCID: PMC5583525 DOI: 10.4240/wjgs.v9.i8.174] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/17/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
It is important that surgeons are familiar with the various manifestations of tuberculosis (TB). Although TB has been declining in incidence in the developed world, it remains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
Collapse
Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
| | - Benjamin Thumamo Pokam
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
| |
Collapse
|
10
|
Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
Collapse
Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
11
|
Evans RPT, Mourad MM, Dvorkin L, Bramhall SR. Hepatic and Intra-abdominal Tuberculosis: 2016 Update. Curr Infect Dis Rep 2016; 18:45. [PMID: 27796776 DOI: 10.1007/s11908-016-0546-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mycobacterium tuberculosis (TB) infection affects nearly 10 million people a year and causes 1.5 million deaths. TB is common in the immunosuppressed population with 12 % of all new diagnoses occurring in human immune deficiency virus (HIV)-positive patients. Extra-pulmonary TB occurs in 12 % of patients with active TB infection of which 3.5 % is hepatobiliary and 6-38 % is intra-abdominal. Hepatobiliary and intra-abdominal TB can present with a myriad of non-specific symptoms, and therefore, diagnosis requires a high level of suspicion. Accurate and rapid diagnosis requires a multidisciplinary team (MDT) approach using radiology, interventional radiology, surgery and pathology services. Treatment of TB is predominantly medical, yet surgery plays an important role in managing the complications of hepatobiliary and intra-abdominal TB.
Collapse
Affiliation(s)
- Richard P T Evans
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Moustafa Mabrouk Mourad
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Lee Dvorkin
- North Middlesex University Hospital, London, UK
| | - Simon R Bramhall
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK.
| |
Collapse
|
12
|
Nebreda T, Álvarez-Prida E, Blanco B, Remacha MA, Samper S, Jiménez MS. Peritoneal tuberculosis due to Mycobacterium caprae. IDCases 2016; 4:50-2. [PMID: 27134824 PMCID: PMC4833828 DOI: 10.1016/j.idcr.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 11/16/2022] Open
Abstract
The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.
Collapse
Affiliation(s)
- T Nebreda
- Servicio de Microbiología, Complejo Asistencial Universitario de León, León, Spain
| | - E Álvarez-Prida
- Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, Spain
| | - B Blanco
- Servicio de Medicina Interna, Complejo Asistencial Universitario de León, León, Spain
| | - M A Remacha
- Servicio de Microbiología, Complejo Asistencial Universitario de León, León, Spain
| | - S Samper
- Instituto de Investigación Sanitaria Aragón, Instituto Aragonés de Ciencias de la Salud, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Zaragoza, Spain
| | - M S Jiménez
- Centro Nacional de Microbiología, Instituto Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
13
|
Sood I, Kasundra GM, Supriya PS, Gupta A, Bhushan B. A rare case of occult abdominal tuberculosis with Poncet's disease mimicking Adult onset Still's disease. J Midlife Health 2015; 6:125-8. [PMID: 26538990 PMCID: PMC4604672 DOI: 10.4103/0976-7800.165593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 50-year-old female presented with fever, symmetrical arthralgias, rash, painful oral ulcerations and alopecia since 8 weeks. Examination showed mild hepatospleenomegaly. Investigations revealed leucocytosis, neutrophilia, elevated sedimentation rate and raised ferritin levels (3850 ng/ml). Computerized tomography (CT) abdomen showed hepatospleenomegaly, mild ascitis and mild bilateral pleural-effusion. After ruling out occult infections, tuberculosis, malignancies and autoimmune diseases by appropriate investigations, and due to raised ferritin levels, adult onset stills disease (AOSD) was diagnosed. Patient responded to oral steroids initially, but after 7 days developed severe abdominal pain. Repeat CT showed multiple enlarged, necrotic and matted retroperitoneal lymph nodes with caseating granuloma on histopathology suggesting tuberculosis. Patient was given four-drug anti-tubercular treatment and she improved. Thus our patient of occult abdominal tuberculosis with reactive arthritis (Poncet's disease) presented with hyperferritinemia mimicking AOSD. We postulate that extreme hyperferritinemia can be seen in tuberculosis and tuberculosis must be conclusively ruled out before diagnosing AOSD in tropics.
Collapse
Affiliation(s)
- Isha Sood
- Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Gaurav M Kasundra
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | | | - Aradhana Gupta
- Department of Pathology, Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| |
Collapse
|
14
|
Abdominal tuberculosis: utility of laparoscopy in the correct diagnosis. J Gastrointest Surg 2015; 19:981-3. [PMID: 25650164 DOI: 10.1007/s11605-015-2753-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features. METHOD We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli. RESULTS Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment. CONCLUSIONS In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.
Collapse
|
15
|
Norbis L, Alagna R, Tortoli E, Codecasa LR, Migliori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther 2014; 12:633-47. [PMID: 24717112 DOI: 10.1586/14787210.2014.899900] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Culture, the classical gold standard for tuberculosis, suffers from increased technical and logistical constraints in EPTB cases. In this review the authors outline current diagnostic options for the main forms of EPTB. The authors also discuss the opportunities and challenges linked in particular to microbiological diagnostics and to the attempts to find a new gold standard test for EPTB. Finally, new biomarkers and tests currently under evaluation are hopefully on the way to introduce significant improvements in EPTB diagnosis, for which clinical suspicion will nevertheless be essential.
Collapse
Affiliation(s)
- Luca Norbis
- San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy
| | | | | | | | | | | |
Collapse
|
16
|
Burke KA, Patel A, Jayaratnam A, Thiruppathy K, Snooks SJ. Diagnosing abdominal tuberculosis in the acute abdomen. Int J Surg 2014; 12:494-9. [PMID: 24560849 DOI: 10.1016/j.ijsu.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite recent improvements in medical treatments, the incidence of abdominal tuberculosis (ATB) in the United Kingdom has increased over the past two decades. This case series examined the difficulties encountered in correctly diagnosing this infection. PATIENTS AND METHODS A retrospective study was undertaken, reviewing the records of 36 patients diagnosed with ATB from 2000 to 2012 at a district general hospital in outer East London. RESULTS The commonest presenting feature was abdominal pain in 67% of patients, and the most common sites of infection were the iliocaecal junction and peritoneum, seen in 36.1% and 33.3% respectively. Six patients were initially investigated for Crohn's disease and one for ileitis. The highest disease prevalence was seen in patients born in India and Pakistan, which was 27.8% and 19.4% of patients respectively. Colonoscopy was performed in nine patients, and three of these reported normal findings. The other six reported visible non-specific inflammatory changes. Three patients had abdominal X-rays reported and one patient had an abdominal ultrasound, all of which were normal. An abdominal computerised topography (CT) scan was performed in 26 patients and a chest CT was undertaken in 19 patients. Varying degrees of inflammatory changes were seen in all of the patients who had CT scans. Microbiological culture was positive for Mycobacterium tuberculosis or acid-fast bacilli in 71% of patients. CONCLUSIONS Abdominal tuberculosis can be very difficult to diagnose as symptoms are non-specific and can mimic other types of granulomatous inflammatory bowel diseases. Radiology appears largely unhelpful due to the non-specificity of any positive imaging findings, and there is a lack of diagnostic procedural and microbiological tests with high specificity and sensitivity. In view of the increasing incidence of tuberculosis in London, there should be a high index of suspicion for ATB in individuals from high-incidence countries who present with non-specific abdominal symptoms.
Collapse
Affiliation(s)
- Kerry A Burke
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Student Office, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK.
| | - Ashish Patel
- University of Southampton, Medical School, Builging 85, Life Sciences Building, Highfield Campus, Southampton SO17 1BJ, UK
| | | | | | - Steven J Snooks
- King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, UK
| |
Collapse
|
17
|
Islam J, Clarke D, Thomson SR, Wilson D, Dawood H. A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis. Surg Endosc 2014; 28:1895-901. [DOI: 10.1007/s00464-013-3410-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/20/2013] [Indexed: 11/27/2022]
|
18
|
Bolognesi M, Bolognesi D. Complicated and delayed diagnosis of tuberculous peritonitis. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:109-12. [PMID: 23826447 PMCID: PMC3700482 DOI: 10.12659/ajcr.883886] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/23/2013] [Indexed: 12/29/2022]
Abstract
Background Peritoneal tuberculosis is very rare in European countries. However, its incidence is increasing due to the continued immigration of people from endemic areas affected by tuberculosis. Case Report: The authors report a case of tuberculous peritonitis in a 46-year-old male patient from North Africa. The presenting symptoms of the disease were hiccups, dyspepsia, anorexia, and weight loss. Physical examination revealed an abdominal distension that suggested the presence of ascites. Subsequent investigations of ultrasound and computed tomography of the abdomen revealed the presence of massive ascites. A diagnostic laparoscopy went on to highlight a macro micronodular degeneration of the peritoneum. Histological examination showed the presence of epithelioid granulomas with typical Langhans cells with areas of caseous necrosis. The diagnosis of tuberculous peritonitis was then made, and the ascites quickly disappeared in response to the anti-mycobacterial therapy. The patient remained free of symptoms after 6 months of clinical follow-up. Conclusions: In this case the clinical diagnosis was complicated and delayed due to clinicians’ suboptimal knowledge of and experience with this disease. This case demonstrates why laparoscopy with peritoneal biopsy should be the gold standard in any clinical suspicion.
Collapse
|
19
|
Mamo JP, Brij SO, Enoch DA. Abdominal tuberculosis: a retrospective review of cases presenting to a UK district hospital. QJM 2013; 106:347-54. [PMID: 23365143 DOI: 10.1093/qjmed/hct003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Peterborough has one of the highest rates of tuberculosis in the East of England; ∼40% of TB treated locally is extra-pulmonary. AIM AND METHODS All adults diagnosed with abdominal tuberculosis (ATB) between January 2008 and September 2011 in Peterborough Hospitals were retrospectively evaluated with regard to their clinical history, investigation, management and outcomes. RESULTS In total, 17 patients diagnosed with ATB were reviewed. All the patients were from (or descended from) high-risk ethnic groups. Four had co-existing pulmonary TB. Intestinal and peritoneal TB were the most common findings. The most common clinical manifestations included abdominal pain (71%), weight loss (59%), diarrhoea (47%) and pyrexia (41%). Fifteen patients had samples sent for microbiological investigation; 1 (6%) was smear positive and 9 (53%) were culture positive. Two (12%) were isoniazid resistant. No rifampicin resistance was detected. Anti-tuberculous therapy was given for 6-12 months. In total, 16 (94%) patients completed the treatment; 1 patient died prior to regime completion (crude mortality: 6%). There was one reported case of pyrazinamide intolerance and two episodes of isoniazid intolerance. DISCUSSION ATB is a diagnostic challenge, especially in absence of lung involvement. It mimics other diseases and clinical presentation is usually non-specific, which may lead to diagnostic delay and development of complications. Extreme vigilance should be used when dealing with unexplained abdominal symptoms to ensure timely diagnosis of ATB. Early diagnosis with early anti-tuberculous therapy and surgical treatment are essential to ensure as positive an outcome as possible.
Collapse
MESH Headings
- Abdominal Pain/microbiology
- Adult
- Aged
- Antitubercular Agents/therapeutic use
- Diarrhea/microbiology
- England/epidemiology
- Female
- Fever/microbiology
- Hospitals, District
- Humans
- Male
- Middle Aged
- Peritonitis, Tuberculous/complications
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/drug therapy
- Peritonitis, Tuberculous/ethnology
- Retrospective Studies
- Treatment Outcome
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/drug therapy
- Tuberculosis, Gastrointestinal/ethnology
- Tuberculosis, Hepatic/complications
- Tuberculosis, Hepatic/diagnosis
- Tuberculosis, Hepatic/drug therapy
- Tuberculosis, Hepatic/ethnology
- Weight Loss
- Young Adult
Collapse
Affiliation(s)
- J P Mamo
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | | | | |
Collapse
|
20
|
Tuberculous lymphadenopathy mimicking pancreatic neoplasm. Case Rep Med 2012; 2012:579297. [PMID: 22851977 PMCID: PMC3407625 DOI: 10.1155/2012/579297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 02/03/2023] Open
Abstract
Abdominal tuberculosis (TB) is the sixth most common location of extrapulmonary TB involvement. Because its symptoms and signs are often nonspecific, laboratory and imaging findings mimic other diseases including carcinoma. Therefore, the diagnosis of abdominal TB is challenging. We herein report a case of 74-year-old woman who presented with abdominal pain, anorexia, and weight loss. She had been given a diagnosis of pancreatic head carcinoma. Laboratory data was unremarkable except for elevated erythrocyte sedimentation rate, CA125, and sIL-2R. CT scan revealed multiple enlarged peripancreatic lymph nodes and concentric thickening of the ileocecal wall. Colonoscopy demonstrated deformed ileocecal valve and erosions. Histological examination showed epithelioid granulomas. Laparoscopy revealed numerous white tubercles diffusely covering the parietal peritoneum. Histopathological images of peripancreatic lymph node revealed large multiple caseating granulomas surrounded by Langhans_giant cells and epithelioid cells. Polymerase chain reaction and culture of the specimens were positive for Mycobacterium tuberculosis. Tuberculous lymphadenopathy, colitis, and peritonitis were finally diagnosed. She responded well to the antitubercular treatment.
Collapse
|
21
|
Tuberculose abdominale : étude rétrospective de 90 cas. Rev Med Interne 2011; 32:212-7. [DOI: 10.1016/j.revmed.2010.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 08/16/2010] [Accepted: 09/19/2010] [Indexed: 11/18/2022]
|
22
|
Pitfalls of diagnostic laparoscopy in abdominal tuberculosis. Surg Endosc 2009; 24:908-10. [PMID: 19760331 DOI: 10.1007/s00464-009-0692-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 07/19/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received. METHODS A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed. RESULTS Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis. CONCLUSION For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.
Collapse
|
23
|
Chen HL, Wu MS, Chang WH, Shih SC, Chi H, Bair MJ. Abdominal tuberculosis in southeastern Taiwan: 20 years of experience. J Formos Med Assoc 2009; 108:195-201. [PMID: 19293034 DOI: 10.1016/s0929-6646(09)60052-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE Abdominal tuberculosis (TB) is a rare manifestation of extrapulmonary TB. This disease entity can be overlooked, and its early diagnosis is difficult because of its variable manifestations and lack of specific symptoms. METHODS The clinical and diagnostic features, treatment, and outcome of patients with abdominal TB at a major hospital in southeastern Taiwan from January 1987 to December 2006 were investigated. RESULTS Twenty-one patients with abdominal TB identified during the 20-year period were included. A predominance of male (13/21, 61.9%) and Taiwanese aborigine (15/21, 71.4%) patients was noted. Middle-aged (30-50 years) patients with alcoholic liver cirrhosis had the highest risk. Common presenting features included abdominal pain (18/21, 85.7%), fever (16/21, 76.2%), ascites (13/21, 61.9%), and weight loss (12/21, 57.3%). The mean time to reach a diagnosis was 48 +/- 10 days. Tuberculous peritonitis was noted in 11 patients, with a high correlation with liver cirrhosis (p = 0.0237, Fisher's exact test). The other patients were diagnosed with TB of the gastrointestinal tract (n = 6), urinary tract (n = 2), and pelvis (n = 2). Abdominal sonography and abdominal computed tomography were helpful for diagnosis, by revealing ascites and thickening of the peritoneum. Pulmonary involvement was noted in 11 patients. Most of the patients (16/21, 76.2%) improved with anti-tuberculosis therapy, and five patients died from sepsis and respiratory failure. CONCLUSION Abdominal TB is a rare manifestation of extrapulmonary TB, even in southeastern Taiwan where TB is prevalent. Delay in diagnosis is common and abdominal TB should be included in the differential diagnosis of middle-aged aborigine men with alcoholic liver cirrhosis and peritonitis.
Collapse
Affiliation(s)
- Huan-Lin Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has increased, and the morbidity and mortality resulting from a delayed diagnosis or misdiagnosis is considerably high. In this article, we examine the changing trends in the epidemiology of CD and ITB, in addition to clinical features that aid in the differentiation of both diseases. The value of various laboratory, serological, and the tuberculin skin tests are reviewed as well. The use of an interferon-gamma-release assay, QuantiFERON-TB Gold, in the workup of these patients and its value in populations where the bacillus Calmette-Guérin vaccine is still administered is discussed. Different radiological, endoscopic, and pathological similarities and features that can aid the clinician in reaching a rapid diagnosis are reviewed as well. The association between mycobacteria and CD, the concerns with the practice of antituberculosis medication trials in areas where tuberculosis (TB) is endemic, as well as extrapulmonary TB induced by the use of antitumor necrosis factor-alpha agents are delineated in this article. Furthermore, we propose an algorithm for the investigation of patients in whom the differential diagnosis encompasses CD and ITB.
Collapse
|
25
|
Abstract
This is a case report of tuberculous peritonitis (TB), an entity which is difficult to diagnose. When TB is found in extrapulmonary organs it is usually associated with an immunocompromised state, such as that caused by the human immunodeficiency virus (HIV). Medical therapy continues to be the treatment of choice and, if the correct diagnosis is made early, surgery is rarely required.
Collapse
|
26
|
Liu DP, He QJ, Wang XM, Sun MJ. Clinical outcome analysis of epiploon biopsy in the diagnosis of patients with tuberculous peritonitis. Shijie Huaren Xiaohua Zazhi 2008; 16:567-569. [DOI: 10.11569/wcjd.v16.i5.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical practical value of epiploon biopsy in the diagnosis of tuberculous peritonitis.
METHODS: A total of 152 ascetic patients with uncertain diagnosis were selected to puncture the thickened peritoneum under the guidance of ultrasonic puncture probe. Biopsy tissue was sent for pathological examination. Serum PPD, ESR and CRP were and LDH in ascites were detected. Abdomen was examined by X-rays.
RESULTS: The success rate of epiploon biopsy was 96.05%. Of the 152 patients, 64 were diagnosed as tuberculous peritonitis, accounting for 42.11% of ascetic patients with uncertain diagnosis. The positive rate of epiploon biopsy was obviously higher than that of traditional clinical examinations. Serum ESR (χ2 = 1.265, P = 0.261), PPD (χ2 = 26.669, P = 0.000), CRP (χ2 = 8.125, P = 0.004) and LDH in ascites (χ2 = 20.403, P = 0.000) and positive findings of abdominal X-ray findings (χ2 = 7.169, P = 0.007) were increased in tuberculous peritonitis patients with a significantly statistical difference (P < 0.05). Following pathologic findings of TB were observed in peritoneal tissue samples: cheese necrosis, Langhan's cells-like and epithelial cells-like multinucleated giant cells, a large number of fibers within adipose tissue.
CONCLUSION: Percutaneous biopsy can be confirmed tuberculosis peritonitis, secure, reliable, less restriction on the use, is one of the most practical clinical means of inspection.
Collapse
|
27
|
Abstract
OBJECTIVE Reports suggest that the rates of tuberculosis (TB) continue to rise in the UK and throughout the world. The spread of the disease is aided by poverty, overcrowding, co-infection with human immunodeficiency virus and drug resistance. Consistent with the overall trend, intra-abdominal and gastrointestinal (GI) TB rates are rising. Tuberculosis is a treatable disease, whether occurring in the lungs or at extra-pulmonary sites but the nonspecific features of the disease result in difficulty in establishing a diagnosis. In this report, we have concentrated on the benefits and potential pitfalls of diagnostic methods. METHOD A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords diagnosis, management, abdominal and GI TB. RESULTS Abdominal TB presents a particular challenge, as the diverse features of the disease do not readily suggest a particular diagnosis and diagnostic delays lead to significant morbidity and mortality. A number of investigative methods have been used to aid in the diagnosis of abdominal and GI TB. CONCLUSION The nonspecific presentation of abdominal and GI TB present challenges in the diagnosis of this increasingly common disease. A high index of suspicion is an important factor in early diagnosis. After a diagnosis has been established, prompt initiation of treatment helps prevent morbidity and mortality.
Collapse
Affiliation(s)
- S Rasheed
- St Mark's Hospital, Harrow, Middlesex, UK
| | | | | | | | | |
Collapse
|
28
|
|
29
|
Cheung HYS, Siu WT, Yau KK, Yang GPC, Li MKW. Abdominal Tuberculosis Mimicking Metastasis in a Patient with Carcinoma of the Oesophagus. Asian J Surg 2006; 29:49-50. [PMID: 16428101 DOI: 10.1016/s1015-9584(09)60296-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Oesophageal carcinoma typically manifests as ulcerative growth. Cases of oesophageal tuberculosis mimicking carcinoma of the oesophagus have been reported and create considerable diagnostic difficulty. Abdominal tuberculosis, however, is an uncommon extrapulmonary manifestation of tuberculosis. Here, we report a case of abdominal tuberculosis in a patient with squamous carcinoma of the oesophagus.
Collapse
Affiliation(s)
- Hester Yui Shan Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
30
|
Cheung HYS, Siu WT, Yau KK, Ku CF, Li MKW. Acute abdomen: an unusual case of ruptured tuberculous mesenteric abscess. Surg Infect (Larchmt) 2005; 6:259-61. [PMID: 16128633 DOI: 10.1089/sur.2005.6.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abdominal tuberculosis is an uncommon extra-pulmonary manifestation of tuberculosis. METHODS Case report and literature review. RESULTS Herein, we report an unusual case of ruptured tuberculous mesenteric cold abscess, which was managed by laparotomy for diagnosis and drainage, and post-operative chemotherapy. CONCLUSIONS Peritoneal tuberculosis may present to surgeons as ascites, an abdominal mass, or peritonitis. Preoperative diagnosis of abdominal tuberculosis is notoriously difficult. Acute peritonitis provoked by rupture of tuberculosis mesenteric cold abscess is exceedingly rare. Surgical intervention is warranted for diagnosis and drainage.
Collapse
Affiliation(s)
- Hester Yui Shan Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China
| | | | | | | | | |
Collapse
|
31
|
Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: Experience from 11 cases and review of the literature. World J Gastroenterol 2004; 10:3647-9. [PMID: 15534923 PMCID: PMC4612009 DOI: 10.3748/wjg.v10.i24.3647] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.
METHODS: The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.
RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white ‘miliary nodules’ or plaques, enlarged lymph nodes, ascites, ‘violin string’ fibrinous strands, and omental thickening. Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis (M. tuberculosis) in all cases.
CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.
Collapse
Affiliation(s)
- Ali Uzunkoy
- Department of Surgery, University of Harran, Faculty of Medicine, Sanliurfa, Turkey
| | | | | |
Collapse
|
32
|
|
33
|
Petrou M, Vassiliou V. Diagnosis of abdominal tuberculosis. J R Soc Med 2004. [PMID: 14996980 DOI: 10.1258/jrsm.97.3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
34
|
Singh-Ranger D. Diagnosis of abdominal tuberculosis. J R Soc Med 2004. [PMID: 14996978 DOI: 10.1258/jrsm.97.3.154-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|