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Shahid Y, Anis MA, Abid S. Foregut tuberculosis: Too close but miles apart. World J Clin Cases 2024; 12:6517-6525. [DOI: 10.12998/wjcc.v12.i32.6517] [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: 03/28/2024] [Revised: 06/12/2024] [Accepted: 07/31/2024] [Indexed: 09/24/2024] Open
Abstract
The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.
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Affiliation(s)
- Yumna Shahid
- Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | | | - Shahab Abid
- Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi 74800, Pakistan
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Alvizuri C, Carlín A, Aguilar V, Valenzuela V. Gastroduodenal and Colorectal Tuberculosis: Report of 2 Cases. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:21-25. [PMID: 38020816 PMCID: PMC10661711 DOI: 10.1159/000527203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2023]
Abstract
Introduction Tuberculosis remains a public health concern in developing countries, as well as in developed countries as a result of immigration from endemic areas. Gastroduodenal and colorectal tuberculosis are rare manifestations of gastrointestinal infection. Case Presentation We present 2 cases of gastric, duodenal, and colorectal tuberculosis. The first case, a 17-year-old male with no medical record, presented with chronic diarrhea and abdominal pain. At endoscopy, he had multiple ulcers in the stomach, colon, and rectum, which were positive to Mycobacterium tuberculosis. The second case was a 43-year-old HIV-positive male, with a history of intermittent fever, nausea, and vomiting. Upper gastrointestinal endoscopy revealed a deep ulcer on gastric fundus that tested positive to M. tuberculosis in the acid-fast bacilli staining. Discussion/Conclusion Gastroduodenal and colorectal tuberculosis, although rare, should be considered in the differential diagnosis in both immunosuppressed and immunocompetent patients. An adequate tissue sample and appropriate diagnostic tests are essential for the diagnosis and prompt start of first-line antituberculosis agents.
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Affiliation(s)
- Claudia Alvizuri
- Department of Gastroenterology, Cayetano Heredia National Hospital, Lima, Peru
| | | | - Víctor Aguilar
- Department of Gastroenterology, Cayetano Heredia National Hospital, Lima, Peru
| | - Vanessa Valenzuela
- Department of Gastroenterology, Cayetano Heredia National Hospital, Lima, Peru
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Yan F, Yu X, Lei H, Chen Y, Wang J, Li J. A rare case of gastric fundus tuberculosis with nonspecific abdominal pain. J Int Med Res 2021; 49:3000605211033189. [PMID: 34311596 PMCID: PMC8320578 DOI: 10.1177/03000605211033189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
A 53-year-old patient who experienced recurring upper abdominal pain and discomfort for 4 years was admitted to our hospital. Gastroscopy was performed to identify the location of the pain and evaluate the characteristics of a mass in the abdomen. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) revealed a space-occupying lesion in the gastric fundus, suggestive of a submucosal tumor and highly likely of stromal origin. Surgical resection of the lesion was performed for identification; however, postoperative histopathological examination of the lesion revealed gastric fundus tuberculosis (TB). Gastric TB is relatively rare; therefore, clinicians should be highly suspicious of patients with abdominal symptoms from regions with a high incidence of TB to prevent treatment delay caused by misdiagnosis.
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Affiliation(s)
- Feiyu Yan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Xianzhe Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Hongjun Lei
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Yi Chen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Jiwei Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Jianguo Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
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Elzein F, Kharraz R, Boudal A, Mohamed H, Mursi M, Kuriry H, Albarrak A, AlSherbeeni N. Abdominal tuberculosis in a tertiary care centre in Saudi Arabia. Indian J Tuberc 2020; 68:236-241. [PMID: 33845958 DOI: 10.1016/j.ijtb.2020.09.007] [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] [Received: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Abdominal tuberculosis (ATB) is the second most common type of extra-pulmonary tuberculosis. Though it does not usually pose a significant risk of infectivity, ATB can go unidentified and progress to disseminated infection. The aim of this study is to highlight the incidence and outcome of this infection in a tertiary care centre in the Kingdom of Saudi Arabia (KSA). METHODS In this retrospective study, we included all ATB patients admitted to our centre between January 1 st, 2010 and December 31, 2018. A total of 42 patients with a median age of 49 (range 18-83 years, 78.6% males) were identified. RESULTS The most common presentation was abdominal pain, weight loss, and abdominal distension. All the patients were HIV negative; however, 50% had a comorbid condition, mainly diabetes mellitus, chronic renal failure, and liver cirrhosis. Tuberculous peritonitis was the predominant type of ATB. Suspicious and potentially malignant abdominal masses appeared on the abdominal CT scans of six patients. This suggest that TB should be excluded in patients from endemic area presenting with abdominal masses. All patients received standard anti-tuberculous medication for an average duration of 7.4 months. The outcome was excellent with 88%% achieving complete response. Adjunctive corticosteroids were not used, and none of the patients had a surgical complication. CONCLUSION The diagnosis of ATB is challenging. It can mimic inflammatory bowel disease in young populations and malignancy in middle-aged and elderly population. For this reason, a high index of suspicion with prompt treatment is required to improve the prognosis and prevent complications.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Razan Kharraz
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Ayah Boudal
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Haris Mohamed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mohammed Mursi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Hadi Kuriry
- Hepatology Unit, Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Ali Albarrak
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Nisreen AlSherbeeni
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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Lv M, Tang K, Meng Y, Tian C, Wang M. Primary isolated asymptomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review. BMC Gastroenterol 2020; 20:108. [PMID: 32293275 PMCID: PMC7158059 DOI: 10.1186/s12876-020-01242-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/27/2020] [Indexed: 11/27/2022] Open
Abstract
Background Primary isolated gastric TB of the cardia presenting as a submucosal tumor is extremely rare. Case presentation A 60-year-old female was admitted to our department; endoscopy revealed a smooth protruding lesion in the gastric cardia. The patient was diagnosed with a gastric cardia stromal tumor and the lesion was seen in muscularis propria by endoscopic ultrasonography (EUS). Endoscopic submucosal dissection (ESD) revealed that the lesion was filled with a milky, white liquid and white granulation tissue. Acid-fast specimen staining was negative. Hematoxylin and eosin staining showed patches of caseating necrosis and granulomatous inflammation. Gene sequencing subsequent to polymerase chain reaction (PCR) analysis of the ESD specimen identified Mycobacterium tuberculosis (M. TB) DNA fragments. The patient was put on ATT for 6 months. Conclusion Primary isolated gastric TB of the cardia should be suspected in patients without clinical symptoms whose manifestations are similar to those associated with submucosal tumors. TB-PCR may be helpful for further diagnosis.
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Affiliation(s)
- Mingnan Lv
- Department of Gastroenterology, The People's Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing, 408400, China
| | - Kejiang Tang
- Department of Gastroenterology, The People's Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing, 408400, China
| | - Yajie Meng
- Department of Gastroenterology, The People's Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing, 408400, China
| | - Chuan Tian
- Department of Gastroenterology, The People's Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing, 408400, China
| | - Min Wang
- Department of Gastroenterology, The People's Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing, 408400, China.
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Ma J, Yin H, Xie H. Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature. BMC Infect Dis 2019; 19:589. [PMID: 31277586 PMCID: PMC6612222 DOI: 10.1186/s12879-019-4225-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Backgroud Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis. Case presentation A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches. Conclusion Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.
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Affiliation(s)
- Jun Ma
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Department of Tuberculosis and Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Hongyun Yin
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Huikang Xie
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Pathology department, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
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Chaudhary P, Khan AQ, Lal R, Bhadana U. Gastric tuberculosis. Indian J Tuberc 2018; 66:411-417. [PMID: 31439189 DOI: 10.1016/j.ijtb.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
Tuberculosis of the stomach is an extremely rare manifestation of Mycobacterium tuberculosis infection and mimics gastric carcinoma in its presentation. Most of our knowledge about this rare disease comes from case reports and there are only a few case series published on this disease and thus the majority of the part remains uncovered. Diagnosis is made commonly only after a major surgery. Endoscopy and guided biopsy are the diagnostic modality of choice. Surgery is indicated in cases which present with complications. Patients respond well to antituberculous therapy. The authors encountered 4 cases of gastric tuberculosis over 5 years. This study summarises the available literature and gives comprehensive update on this rare disease.
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Affiliation(s)
- Poras Chaudhary
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India.
| | - Abdul Qayoom Khan
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Romesh Lal
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Utsav Bhadana
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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Eray İC, Rencüzoğulları A, Yalav O, Dalcı K, Kakil E, Bağır E, Parsak CK. Primary gastric tuberculosis mimicking gastric cancer. ULUSAL CERRAHI DERGISI 2015; 31:177-9. [PMID: 26504425 DOI: 10.5152/ucd.2014.2667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/09/2014] [Indexed: 11/22/2022]
Abstract
A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.
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Affiliation(s)
- İsmail Cem Eray
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Rencüzoğulları
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Orçun Yalav
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Kubilay Dalcı
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Erdem Kakil
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Emine Bağır
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Cem Kaan Parsak
- Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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Ishii N, Furukawa K, Itoh T, Fujita Y. Primary gastric tuberculosis presenting as non-healing ulcer and mimicking Crohn's disease. Intern Med 2011; 50:439-42. [PMID: 21372454 DOI: 10.2169/internalmedicine.50.4634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old woman was referred to our hospital for treatment of a non-healing gastric ulcer. Esophagogastroduodenoscopy (EGD) revealed an erosion in the pyloric antrum and a longitudinal ulcer on the lesser curvature of the gastric body. The histopathologic examination of biopsy specimens revealed non-caseating epithelioid granulomas. Acid-fast staining did not reveal bacilli. The differential diagnosis included gastric tuberculosis, Crohn's disease, and sarcoidosis and empiric antituberculous therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide was initiated. Gastric lesions were subsequently resolved and non-caseating epithelioid granulomas were not demonstrated on the post-treatment examination. Recurrence was not observed during the follow-up period of 53 months.
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Affiliation(s)
- Naoki Ishii
- Department of Gastroenterology, St. Luke's International Hospital, Japan.
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