Abstract
Abdominal tuberculosis (TB) occurs only in a subset of TB-infected persons. With a higher incidence in the immunocompromised population, successful treatment includes early diagnosis and initiation of anti-TB medications. This case report discusses a 22-year-old immunocompetent male diagnosed with advanced duodenal and peritoneal TB after perforation requiring emergent surgery and intravenous anti-TB treatment secondary to lack of enteral access.
Highlights
Tuberculosis (TB) is a curable and preventable infection caused by Mycobacterium tuberculosis
Intravenous rifampin was used in conjunction with enteral solutions of pyrazinamide, isoniazid, and ethambutol compounded by pharmacy for administration via jejunostomy tube
Extra-pulmonary TB affects less than 20% of TB infected patients with abdominal TB seen in 6-38%
Summary
Tuberculosis (TB) is a curable and preventable infection caused by Mycobacterium tuberculosis. It most commonly infects those who are immunocompromised and is more prevalent in endemic areas. Infection may include tubercular lymphadenopathy, peritoneal, gastrointestinal (GI), or visceral sites; duodenal TB is significantly rare and represents only two percent of all intrabdominal cases [2]. Pharmacologic management with anti-TB medications is often sufficient for treatment of abdominal TB; a four-drug combination of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) remains the standard of care [3]. Intravenous (IV) anti-TB medications may be considered in patients with extensive intestinal involvement, limited enteral access, those who have failed oral treatment or those with multidrug resistance. Significant peritoneal and GI TB and required extensive surgical and pharmacologic intervention with IV anti-TB medications
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