AB 75. Abdominal tuberculosis: presentation of two cases
Background: The presentation of two cases with tuberculous enteritis and tuberculous peritonitis respectively.
Patients and methods: Case 1. Α 53 year old immigrant male, with a past medical history of pulmonary tuberculosis and previous treatment, presented with anorexia, fatigue, intermittent abdominal pain, hoarseness and loss of weight during the past month. Chest radiography showed fibrotic scars and volume loss of the left upper lobe, while laryngoscopy revealed ulceration and oedema at the left aryepiglottic fold. On day 2 of his hospitalization in ENT clinic, patient presented acute abdominal pain, requiring surgical intervention. Surgical findings were a perforation of the small intestine, an edematous and friable mucosa and a widespread of ulcers. Bowel resection and end-to-end anastomosis were performed. Pathology results of the obtained biopsy samples from the small intestine and larynx revealed the presence of chronic caseating granuloma. Anti-tuberculous treatment with INH, RIF, PZ and EMB was administrated and patient improved gradually. Case 2. A 69 year old female with a medical history of end-stage renal disease treated with continuous ambulatory peritoneal dialysis, presented with fever, fatigue and abdominal pain during the past weeks. Chest radiography showed fibrotic scars of the upper lobes and CT of the abdomen was normal. The number of cells in peritoneal dialysis fluid was increased with a predominance of polymorphonuclear cells. An initial diagnosis of bacterial peritonitis was made and broadspectrum antibiotics were administrated, without improvement. The cultures of the peritoneal fluid were negative for common bacteria. Tuberculin sensitivity test was positive. The Ziehl-Neelsen stain of the peritoneal fluid was positive for acid-fast bacilli and culture identified Mycobacterium Tuberculosis. Αnti-tuberculous treatment with INH, RIF, PZ and EMB was started and patient responded promptly with resolution of abdominal pain and remission of fever.
Conclusions: A high index of suspicion must be maintained for abdominal tuberculosis in high-risk for tuberculosis patients who present with abdominal symptoms.
