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Abstract
RATIONALE Intestinal tuberculosis (TB) is rarely seen in patients with end-stage renal disease (ESRD). We report an intestinal TB case with a clinical presentation similar to that of colon cancer in a patient with ESRD on hemodialysis. PATIENT CONCERNS A 49-year-old man presented with a 3-month history of general weakness and anorexia. He had been treated for stage 5 chronic kidney disease (CKD) due to diabetic nephropathy for the last 3 years. His blood urea nitrogen and serum creatinine levels were 96.9 and 8.1 mg/dL, respectively, at the time of admission; azotemia was accompanied by severe anemia, hypoalbuminemia, hyperkalemia, and metabolic acidosis. Hemodialysis was initiated for suspected exacerbation of uremia; however, intermittent fever, night sweats, and abdominal discomfort persisted. DIAGNOSES Abdominal computed tomography (CT) and whole-body F-fluorodeoxyglucose positron emission tomography were indicative of ascending colon cancer with lymph node metastases. However, colonoscopy with biopsy revealed the formation of submucosal caseating granuloma and acid-fast bacillus. INTERVENTIONS We initiated quadruple therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient continued the quadruple regimen for the first 2 months before switching to dual therapy and received anti-TB medications for a total of 12 months. OUTCOMES After 9 months of standard anti-TB chemotherapy, polypoid residual lesions were noted during follow-up colonoscopy. Laparoscopy-assisted ileocecal resection was performed. No findings suggestive of recurrence of colonic TB were observed on follow-up abdominal CT at 6 months after discontinuation of anti-TB medications. LESSONS If non-specific uremic symptoms persist in patients with advanced CKD, the possibility of extrapulmonary TB such as intestinal TB must be considered. Also, in patients with radiologic suspicion of colon cancer, endoscopy with biopsy should be performed promptly to exclude colonic TB with similar clinical manifestations.
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Affiliation(s)
| | | | | | | | - Sungmin Kang
- Department of Nuclear Medicine, Daegu Catholic University School of Medicine, Daegu
| | - Min-Kyung Kim
- Department of Pathology, Dongguk University College of Medicine, Gyeongju
| | - Dong Jik Ahn
- Department of Internal Medicine, HANSUNG Union Internal Medicine Clinic and Dialysis Center, Daegu, Republic of Korea
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2
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Anazawa R, Suzuki M, Miwa H, Miki Y, Tomita K, Nakamura H. [A case of esophageal and intestinal tuberculosis that occurred during treatment of rheumatoid arthritis with etanercept]. Kekkaku 2014; 89:711-716. [PMID: 25283012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An 88-year-old woman with rheumatoid arthritis who had started etanercept treatment in July 2011 was referred to our hospital in February 2012 for right-sided pleural effusion. Chest computed tomography showed right pleural effusion, partial swelling of a calcified mediastinal lymph node, and mid-esophageal thickening of the mucosal wall. Gastroendoscopy showed mid-esophageal ulceration. Histological examination of biopsy specimens from this ulceration revealed noncaseating granulomas with Langhans giant cells. Ziehl-Neelsen staining of this section was positive for acid-fast bacilli. Polymerase chain reaction analysis of gastric juice was positive for Mycobacterium tuberculosis; we therefore diagnosed the patient with esophageal tuberculosis. However, since abdominal computed tomography showed swelling of mesenteric lymph nodes, we also suspected intestinal tuberculosis. Colonoscopy showed multiple ileal erosions; histological analyses of biopsied specimens revealed granulomas with Langhans giant cells, similar to the esophageal findings. We finally diagnosed the patient with both esophageal and intestinal tuberculosis. After anti-tuberculosis treatment, the right pleural effusion disappeared and the abdominal lesions improved. Although mycobacterial involvement of both the esophagus and intestine is rare in immunocompromised and immunocompetent hosts, differential diagnosis of these diseases is likely to become more important.
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3
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Hibiya K, Higa F, Tateyama M, Fujita J. [The pathogenesis of the bowel infection with the Mycobacterium tuberculosis]. Kekkaku 2010; 85:711-721. [PMID: 20960951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The prevalence of primary intestinal tuberculosis is increasing with social change and medical progress. However, it remains unknown whether or not primary intestinal tuberculosis exists without the involvement of other internal organs. This review verifies hypotheses about infectious courses of intestinal tuberculosis. We also evaluate the significance of bowel infection. As a result, we found some patients with intestinal tuberculosis who do not have tuberculosis lesions in other internal or external organs, and the tubercle bacillus, which is ordinarily transmitted with airborne droplet nuclei, might cause oral transmission by several factors.
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Affiliation(s)
- Kenji Hibiya
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
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4
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Abstract
A 58-year-old woman experienced recurrent fever episodes after kidney transplantation. She was treated with antibiotics because of suspicion of staphylococcus infection. Abdominal pain combined with haemorrhagic diarrhoea occurred eight months after transplantation. A barium enema revealed a stenotic process in the middle part of the ascending colon mimicking carcinoma, and hemicolectomy was consequently performed. Histological examination revealed tuberculosis with little granuloma formation and abundant acid-fast tubercle bacilli in the mucosa and submucosa, and only slight perigranulomatous reactions. The patient was successfully treated with triple antituberculous chemotherapy without deterioration of allograft function. Tuberculosis should be suspected in immunosuppressed patients suffering from pyrexia of unknown origin, even when chest X-ray is normal.
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5
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Guerrero-Hernández I, Gallegos-Orozco JF, Weimersheimer-Sandoval M. [Clinical images in gastroenterology. C3 AIDS and generalized infection of the intestine by mycobacteria]. Rev Gastroenterol Mex 2007; 72:380. [PMID: 18595329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ignacio Guerrero-Hernández
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México Distrito Federal.
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6
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Shimzukawa M, Sakakibara T, Sato M, Okayama H, Miki M, Nakagawa K, Miura M, Ishii T, Sato Y. [Tuberculosis in two patients after administration of etanercept for rheumatoid arthritis]. ACTA ACUST UNITED AC 2007; 96:1476-8. [PMID: 17682437 DOI: 10.2169/naika.96.1476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Minoru Shimzukawa
- Department of Respiratory medicine, Japanese Red Cross Sendai Hospital, Sendai
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7
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Kuwabara K, Hirata A, Saito Y, Ohdaira T, Tsuchiya T. [Paradoxical reactions during nutritional improvement in pulmonary tuberculosis patient with severe malnutrition]. Nihon Naika Gakkai Zasshi 2006; 95:2286-8. [PMID: 17168403 DOI: 10.2169/naika.95.2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Katsuhiro Kuwabara
- Department of Pulmonary Diseases, National Nishi-Niigata Chuou Hospital, Niigata
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8
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García-Díaz RA, Ruiz-Gómez JL, Rodríguez-Sanjuan JC, García-Palomo D, Gómez-Fleitas M. Perforation of the colon caused by intestinal tuberculosis. Dis Colon Rectum 2006; 49:927; author reply 927. [PMID: 16550318 DOI: 10.1007/s10350-006-0542-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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9
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Schneider T, Ulrichs T, Loddenkemper C, Lode H, Zeitz M, Scherübl H. [Intestinal tuberculosis: a clinical and diagnostic challenge]. Dtsch Med Wochenschr 2004; 129:1747-52. [PMID: 15295686 DOI: 10.1055/s-2004-829027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- T Schneider
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik (Gastroenterologie, Infektiologie und Rheumatologie).
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10
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Kandutsch S, Feix A, Haas M, Häfner M, Sunder-Plassmann G, Soleiman A. A rare cause of anemia due to intestinal tuberculosis in a renal transplant recipient. Clin Nephrol 2004; 62:158-61. [PMID: 15356975 DOI: 10.5414/cnp62158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A renal transplant recipient with stable allograft function presented with massive hemorrhagic diarrhea and severe anemia. No microbial infection could be found in stool cultures. Early colonoscopy showed severe colitis with ulceration. Histological samples confirmed granulomatous inflammation with acid-resistant Ziehl-Neelson-positive microorganisms of mycobacterial type. Polymerase chain reaction (PCR) analysis of native mucosal biopsies specified the infectious organism as Mycobacterium tuberculosis complex. The patient responded well to antimycobacterial therapy and was still asymptomatic after 6 months with a stable graft function. Our case shows that tuberculosis can be a severe clinical problem in transplant recipients. Most of the patients with intestinal tuberculosis, reported to literature, were diagnosed post mortem or after explorative laparotomy and bowel resection. Thus, intestinal tuberculosis should be considered when a transplant recipient shows abdominal symptoms with no clear evidence of another infection. Proper diagnosis and treatment resulted in a beneficial outcome in our patient.
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Affiliation(s)
- S Kandutsch
- Clinical Institute of Pathology, Department of Medicine III, Vienna General Hospital, University of Vienna, Austria
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11
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Ismail Y, Muhamad A. Protean manifestations of gastrointestinal tuberculosis. Med J Malaysia 2003; 58:345-9. [PMID: 14750373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
We present 11 cases to illustrate the protean presentations of gastrointestinal tuberculosis. The patients presented with perianal fistula, appendicitis, ascites, rectal, intestinal or gastric 'growth', "ulcerative colitis", or recurrent anemia. In some of these cases there was no conclusive proof of infection with Mycobacterium tuberculosis but they responded well to empirical treatment with anti-tuberculous therapy. These cases illustrate that because signs and symptoms of intestinal tuberculosis are non-specific and even histology can be misleading, the diagnosis of gastrointestinal tuberculosis requires a high index of suspicion. A therapeutic trial of antituberculous drugs should be considered for patients with a high clinical suspicion of tuberculosis.
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Affiliation(s)
- Y Ismail
- Kedah Medical Centre, Alor Setar
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12
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Roth S, Delmont E, Heudier P, Kaphan R, Cua E, Castela J, Verdier JM, Chichmanian RM, Fuzibet JG. [Anti-TNF alpha monoclonal antibodies (infliximab) and tuberculosis: apropos of 3 cases]. Rev Med Interne 2002; 23:312-6. [PMID: 11928379 DOI: 10.1016/s0248-8663(01)00556-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Monoclonal TNF alpha antibodies are a new treatment of severe rheumatoid arthritis. One of the possible side effects is the appearance of opportunistic infections. We report here on three cases of disseminated tuberculosis observed in patients undergoing treatment with infliximab. EXEGESIS A 45-year-old woman, treated with infliximab, was hospitalised after five infusions for fever and dyspnoea. The exams showed pulmonary and peritoneal tuberculosis. The second case is a 75-year-old woman whose symptoms were fever, cough and cervical adenopathy after three infliximab infusions. Diagnosis was disseminated tuberculosis. The third case is a 59-year-old man who was hospitalised for an infectious syndrome with dyspnoea, after two infliximab infusions. We discovered pulmonary tuberculosis. CONCLUSION These three cases added to the 68 cases of tuberculosis registered with the treatment of infliximab. This confirms the risk of severe opportunist infectious side effects. TNF alpha is a cytokine which has anti-infectious properties. These tuberculoses are severe and generalized. It is recommended to search for an active or latent tuberculosis before beginning treatment with infliximab, and to check these patients frequently.
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Affiliation(s)
- S Roth
- Service de médecine interne I, hôpital de l'Archet 1, CHU, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice, France
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13
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McGarvey JA, Bermudez LE. Phenotypic and genomic analyses of the Mycobacterium avium complex reveal differences in gastrointestinal invasion and genomic composition. Infect Immun 2001; 69:7242-9. [PMID: 11705893 PMCID: PMC98807 DOI: 10.1128/iai.69.12.7242-7249.2001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium avium and Mycobacterium intracellulare are closely related organisms and comprise the Mycobacterium avium complex. These organisms share many common characteristics, including the ability to cause life-threatening respiratory infections in people with underlying lung pathology or immunological defects and occasionally in those with no known predisposing conditions. However, the ability to invade the mucosa of the gastrointestinal tract and cause disseminated disease in AIDS patients has not been epidemiologically linked to M. intracellulare and appears to be unique to M. avium. We compared the abilities of M. avium and M. intracellulare to tolerate the acidic conditions of the stomach, to resist the membrane-disrupting activity of cationic peptides, and to invade intestinal epithelial cells in vitro and in vivo. We observed that M. avium and M. intracellulare were both tolerant to the acidic conditions encountered in the stomach and resistant to cationic peptides. However, when strains of M. avium and M. intracellulare were examined for their ability to enter cultured human intestinal cells or mouse intestinal mucosa, we observed that M. avium could invade more efficiently than M. intracellulare. To elucidate the basis of this pathogenic difference and identify genes involved in the invasion of the intestinal mucosa, we performed chromosomal DNA subtractive hybridization using M. avium and M. intracellulare chromosomal DNAs. In all, 21 genes that were present in M. avium but absent in M. intracellulare were identified, including some that may be associated with the ability of M. avium to invade the intestinal mucosa.
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Affiliation(s)
- J A McGarvey
- Kuzell Institute of Infectious Disease, California Pacific Medical Center Research Institute, San Francisco, California 94115, USA
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14
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Lee CT, Ng SH, Ko SF, Wan YL, Liu JW, Chen JB. Culture-negative tuberculous enterovesical fistula mimicking late urological complications after radiotherapy. Int J Tuberc Lung Dis 2001; 5:687. [PMID: 11467376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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15
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Nemoto R, Nakamura I, Honjyo I, Takahashi M, Abe C. Tuberculous enteritis after intravesical bacillus Calmette-Guerin therapy: a case of mistaken identity. J Urol 1998; 159:2091-2. [PMID: 9598533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Nemoto
- Department of Urology and Internal Medicine, Tottori Prefectural Central Hospital, Japan
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16
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Sève P, Boibieux A, Bouhour D, Gérard M, Neyret C, Peyramond D. [Intestinal lymphangiectasis associated with ileal tuberculosis]. Presse Med 1998; 27:19. [PMID: 9767758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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17
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Gotor MA, Mur M, Marrón S, Guerrero L. [Anal tuberculosis as the first manifestation of a pulmonary tuberculosis]. Gastroenterol Hepatol 1997; 20:476-7. [PMID: 9445748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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[Surgical abdomen in a patient with human immunodeficiency virus infection]. Rev Clin Esp 1996; 196:264-9. [PMID: 8701072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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19
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Iuditskiĭ MV, Gol'dshteĭn VD, Gorchakov VK, Nesvetov AM, Chebotareva TS. [A case of ulcerative tuberculosis of the stomach in a patient with multiple pulmonary tuberculomas]. Probl Tuberk 1996:57-8. [PMID: 9026812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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20
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Frühmorgen P. [Rare infectious colitis: diagnosis and therapy]. Bildgebung 1995; 62 Suppl 1:47-9. [PMID: 7670304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P Frühmorgen
- Medizinische Klinik I, Klinikum Ludwigsburg, Deutschland
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21
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Onizuka O, Kawano M, Aso S. [A case of tuberculous anal fistulae complicated by pulmonary tuberculous]. Kekkaku 1994; 69:689-92. [PMID: 7837722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Tuberculous involvement of the anus is very rare at present as the result of BCG-Vaccination and improvement of public health. We report a juvenile case of tuberculous anal fistulae complicated to pulmonary tuberculosis. A 22-year-old male was admitted with symptoms of 13 month- history of intermittent anal pain, low grade fever and cough. Chest X-ray showed bilateral middle zone infiltrates with cavitation. Perianal inspection revealed a large ulcer with purulent exudate and a few fistulae. Sputum smears showed acid fast bacilli. A biopsied specimen of perianal fistulae showed granulomatous lesions with central necrosis, epitheloid cells and multi-nucleated giant cells. With three-drug antituberculous regimen, his symptoms resolved, radiographic infiltrates improved, and the perianal fistulae were cured. It was speculated that the tuberculous anal fistulae in this case were caused by the dissemination from the pulmonary focus via the hematogeneous and lymphogeneous routes, because any tuberculous lesion was not detected in the gastrointestinal tract and rectum.
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Affiliation(s)
- O Onizuka
- Department of Internal Medicine, National Nishibeppu Hospital, Oita, Japan
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22
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Alyoune M, Nadir S, Merzouk M, Mounadif A, Biadillah MC, Jamil D, Alaoui R, Cherkaoui A. [Tuberculous anal fistulas. 13 cases]. Ann Gastroenterol Hepatol (Paris) 1994; 30:9-11. [PMID: 8192422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Our retrospective study concerns 13 cases of anal tuberculosis fistulas, studied over a period of 12 years, between January 1980 and December 1991. The mean age of our patients was 24 years and they were predominantly male. The diagnosis, which was suspected clinically, was confirmed histologically, either by ridge biopsies of the external orifice of the fistula or by surgical removal of the fistular passage in patients having undergone an initial surgical intervention. In 5 cases, we noted an associated pulmonary tuberculosis involvement. The treatment comprised 2 phases: an antibacillary medical treatment in all cases and a surgical treatment depending on whether the diagnosis was initially based on the ridge biopsies of the external orifice--6 cases (46.15%)--or after removal of the fistular passage--7 cases (53.85%). The outcome was good in all cases.
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23
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Thapa BR, Yachha SK, Mehta S. Abdominal tuberculosis. Indian Pediatr 1991; 28:1093-100. [PMID: 1802856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
MESH Headings
- Child
- Humans
- Peritonitis, Tuberculous/complications
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/etiology
- Peritonitis, Tuberculous/therapy
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/etiology
- Tuberculosis, Gastrointestinal/therapy
- Tuberculosis, Hepatic/complications
- Tuberculosis, Hepatic/diagnosis
- Tuberculosis, Hepatic/etiology
- Tuberculosis, Hepatic/therapy
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/etiology
- Tuberculosis, Lymph Node/therapy
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Affiliation(s)
- B R Thapa
- Division of Pediatric Gastroenterology, PGIMER, Chandigarh
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Abstract
The stimulus for the immune response in Crohn's disease is unknown. In each of 19 cases of Crohn's disease evaluated by electron microscopy, epithelial cells of the ileum contained phagolysosomes with lamellar layers of lipid. These structures, now termed R or reactant bodies, are the proffered antigenic stimulus. They are proposed to be an amalgam of lipid (cholesterol esters, or phospholipids) and bacterial fragments (mycoplasma, mycobacteria or streptococci), which in combination are hypothesized to produce a powerful immunological response analogous to the adjuvant effect. For disease expression to occur, lipids and specific bacterial populations are needed in the bowel lumen. These factors may account for the success of elemental diets that are low in fat in the treatment of Crohn's disease and for the regional distribution of disease along the intestinal tract.
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Affiliation(s)
- W E Roediger
- University Department of Surgery, Queen Elizabeth Hospital, Woodville, Australia
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25
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Soriano V, Tor J, Doménech E, Gabarre E, Muga R, Inaraja L, Casas D, Olazábal J, Clotet B. [Abdominal tuberculosis in patients with acquired immunodeficiency syndrome]. Med Clin (Barc) 1991; 97:121-4. [PMID: 1895796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In individuals with HIV infection, extrapulmonary forms of tuberculosis are considered as opportunistic infections and are included in the diagnosis of AIDS. They often have atypical clinical features. Abdominal participation is uncommon and its diagnosis may be difficult. METHODS The clinical, radiological and pathological features of patients with a diagnosis of AIDS with abdominal tuberculosis in a series of 254 AIDS cases in a general hospital from 1984 to October 1990 were reviewed. RESULTS Tuberculosis developed in 104 (41%) of AIDS patients. In 25 (24%) the disease was exclusively pleuropulmonary and in 79 (76%) extrapulmonary tuberculosis was present, either alone or in association. Extrapulmonary tuberculosis was the first opportunistic infection in 66 AIDS cases (26%). The abdominal participation was demonstrated in 19 patients, with the following localizations: lymph nodes (9), liver (8), spleen (5), ileum (1) and peritoneum (1). Four patients with splenic tuberculosis also had multifocal nodular lesions. CONCLUSIONS Abdominal participation was found in 19 of the 104 AIDS patients with tuberculosis (18%). Lymph node involvement was the most common type. Hepatosplenic tuberculosis had a miliary form or showed multifocal images in echography or computed tomography.
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MESH Headings
- Abdomen
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/diagnosis
- Female
- Humans
- Ileal Diseases/diagnosis
- Ileal Diseases/etiology
- Male
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/etiology
- Retrospective Studies
- Tomography, X-Ray Computed
- Tuberculosis/diagnosis
- Tuberculosis/etiology
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/etiology
- Tuberculosis, Hepatic/diagnosis
- Tuberculosis, Hepatic/etiology
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/etiology
- Tuberculosis, Splenic/diagnosis
- Tuberculosis, Splenic/etiology
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Affiliation(s)
- V Soriano
- Unidad de Enfermedades Infecciosas, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona
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26
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Affiliation(s)
- J M Fitzgerald
- Department of Medicine, Vancouver General Hospital, British Columbia, Canada
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27
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Prakash J, Agrawal BK, Gupta A, Panjiyar DN, Shukla VK. Acute jejunal obstruction in a renal allograft recipient. J Assoc Physicians India 1989; 37:731-2. [PMID: 2632550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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28
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Flückiger F, Deu E, Hausegger K. [Tuberculosis of the duodenum]. ROFO-FORTSCHR RONTG 1989; 150:219-20. [PMID: 2537523 DOI: 10.1055/s-2008-1047010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- F Flückiger
- Karl-Franzens-Universität Graz, Univ.-Klinik für Radiologie
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29
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Kochhar R, Indudhara R, Nagi B, Yadav RV, Mehta SK. Colonic tuberculosis due to atypical mycobacteria in a renal transplant recipient. Am J Gastroenterol 1988; 83:1435-6. [PMID: 3057875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lax JD, Haroutiounian G, Attia A, Rodriguez R, Thayaparan R, Bashist B. Tuberculosis of the rectum in a patient with acquired immune deficiency syndrome. Report of a case. Dis Colon Rectum 1988; 31:394-7. [PMID: 3366040 DOI: 10.1007/bf02564895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tuberculosis of the rectum is a rare disease. A patient with a miliary pattern of pulmonary tuberculosis had a rectal lesion which proved to be tuberculosis. The patient subsequently developed several opportunistic infections characteristic of acquired immune deficiency syndrome. The clinical, endoscopic, radiologic, and histologic findings of this treatable lesion are presented.
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Affiliation(s)
- J D Lax
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York
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31
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Bruckstein AH. Abdominal tuberculosis. N Y State J Med 1988; 88:18-21. [PMID: 3277095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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32
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33
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Bungeţenu G, Anastasatu C. [Current clinical characteristics of intestinal tuberculosis]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol 1987; 36:67-71. [PMID: 3033802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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34
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Nyberg DA, Federle MP, Jeffrey RB, Bottles K, Wofsy CB. Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS. AJR Am J Roentgenol 1985; 145:297-9. [PMID: 3875228 DOI: 10.2214/ajr.145.2.297] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.
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35
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Jozefovics F. [Incidence of secondary intestinal tuberculosis]. Orv Hetil 1983; 124:2402. [PMID: 6646723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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36
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Hatake K, Saito K, Ozawa S. [Case of pulmonary tuberculosis with the development of ileal perforation during chemotherapy]. Kekkaku 1983; 58:267-70. [PMID: 6632489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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37
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Ortuño J, Teruel JL, Marcen R, Gil P, Berenguer A, Zubicoa S, Navarro Berastegui V. Primary intestinal tuberculosis following renal transplantation. Nephron Clin Pract 1982; 31:59-60. [PMID: 7050752 DOI: 10.1159/000182617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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38
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Goldfischer S, Janis M. A 42-year-old king with a cavitary pulmonary lesion and intestinal perforation. Bull N Y Acad Med 1981; 57:139-43. [PMID: 7011457 PMCID: PMC1805200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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39
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MESH Headings
- Diagnosis, Differential
- Duodenal Diseases/diagnostic imaging
- Esophageal Diseases/diagnostic imaging
- Humans
- Intestinal Diseases/diagnostic imaging
- Intestinal Diseases/pathology
- Intestinal Mucosa/pathology
- Peritonitis, Tuberculous/diagnostic imaging
- Radiography
- Stomach Diseases/diagnostic imaging
- Stomach Diseases/pathology
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/diagnostic imaging
- Tuberculosis, Gastrointestinal/drug therapy
- Tuberculosis, Gastrointestinal/etiology
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Hepatic/diagnostic imaging
- Tuberculosis, Splenic/diagnostic imaging
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41
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Muhletaler CA, De Soto L, Gerlock AJ, Pendergrass HP. Radiographic manifestations of gastrointestinal tuberculosis. Rev Interam Radiol 1979; 4:123-30. [PMID: 547370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Barium studies of a gastrointestinal tract and chest radiographs of 109 patients with gastrointestinal tuberculosis were investigated. The type and site of the tuberculous lesions in the bowel, as well as its association with pulmonary tuberculosis and surgical complications, were reviewed. The ileocecal region is the portion of the gastrointestinal tract most frequently involved. The ulcerohypertrophic type of tuberculous lesion was the most common. Thirty-two percent of the patients had a normal chest radiograph. Nineteen patients had a significant surgical complication. Fistulous tracts and intestinal perforation are rare. The radiographic differential diagnosis with regional enteritis and other forms of inflammatory bowel disease is discussed.
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Sasaki S, Akiba T, Suenaga M, Tomura S, Yoshiyama N, Nakagawa S, Shoji T, Sasaoka T, Takeuchi J. Ten years' survey of dialysis-associated tuberculosis. Nephron Clin Pract 1979; 24:141-5. [PMID: 492424 DOI: 10.1159/000181703] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis associated with dialysis was studied at the Renal Unit of the Tokyo Medical and Dental University and Yokosuka Mutual Aid Hospital Kidney Center, in both of which the treatments of chronic renal failure are the same. There are 12 tuberculosis patients out of 367 patients on maintenance hemodialysis from January 1967 to December 1976, an incidence of 3.3%. This was 6-16 times greater than that in the general population of this country according to yearly statistics. The characteristics of dialysis-associated tuberculosis include a high incidence of miliary tuberculosis, especially in aged patients and difficulty in establishing the diagnosis before death. Clinical features which are helpful in the early diagnosis are intermittent high fever of unknown origin, weight loss, anorexia, abnormalities of the central nervous system, erythrocyte sedimentation rate over 100 mm/h, leukocytosis and high value of the C-reactive protein. With the increasing number of dialysis patients, an increase of dialysis-associated tuberculosis is expected and this will be one of the major problems of dialysis patients in future.
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Leclerc JP, Guillemain B, Kaswin R, Celerier M, Dubost C. [Tuberculosis and caustic eso-gastric burns. Critical reflections on one case]. Sem Hop 1977; 53:2493-6. [PMID: 204052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnostic problems which may be raised during caustic oesophago-gastric burns and concommittent tuberculosis, of which the symptoms may be masked by the richness of the initial clinical picture are discussed here. The authors emphasise the necessity of prophylactic anti-tuberculous treatment, before any surgery when there is any suggestion of tuberculosis even siabilised.
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Pulimood BM. Tuberculosis of colon--common or uncommon. J Assoc Physicians India 1976; 24:613-5. [PMID: 1025149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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46
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Soule JC, Matuchansky C, Bitoun A, Parisot C, Bernier JJ. [Gastric complications revealing ganglioperitoneal non-ascitic diffuse tuberculosis]. Ann Med Interne (Paris) 1973; 124:837-40. [PMID: 4801949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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47
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Firooznia H, Seliger G, Abrams RM, Valensi V, Shamoun J. Disseminated extrapulmonary tuberculosis in association with heroin addiction. Radiology 1973; 109:291-6. [PMID: 4742315 DOI: 10.1148/109.2.291] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Twenty cases of tuberculous ileo-colitis with radiographic changes seen in the University College Hospital, Ibadan, Nigeria, are reviewed and the clinical features and radiographic patterns examined. The intestinal lesions in all cases were secondary to healed and active pulmonary tuberculosis. Although the ileo-caecal region is the commonest site of involvement, lesions also occurred in the distal part of the colon and the entire colon was sometimes involved. Rare occurrences, such as the diverticular type, enterolithiasis, tuberculosis presenting as intussusception and as an appendicular mass, are also reported. Four principal radiological types of colonic change emerged from the study, namely, the hyperplastic, the ulcerative, the mixed ulcero-hyperplastic, and the carcinoma-like types. The salient features in the differential diagnosis of ileo-colonic lesions in a tropical setting are discussed.
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50
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