Intestinal Tuberculosis as First Manifestation of Human Immunodeficiency Virus (HIV) Infection. A Single History Snapshot

Miguel F Carrascosa

doi:10.4172/2161-1068.1000141

Abstract

A 33-year-old man was admitted in 1999 because of abdominal pain, fever, and weight loss. After a presumptive diagnosis of acute complicated appendicitis, laparotomy was carried out. Since cecum and terminal ileum showed a `carcinomatous appearance´ ileocecal resection and right hemicolectomy were performed. Pathological assessment revealed the presence of acid-fast bacilli which were later identified as Mycobacterium tuberculosis. There was no evidence of neoplasia. As the patient had been intravenous drug user and had absolute lymphopenia, Human Immunodeficiency Virus serology was requested after surgery, with the result being positive. The patient was placed on standard antituberculous therapy and was discharged. However, he decided to stop quickly the treatment and was readmitted 3 month after discharge because of fever and cervical lymphadenitis. Culture of a neck lymph node sample grew Mycobacterium tuberculosis. This time, the patient took appropriately antituberculous drugs and also initiated antiretroviral treatment. Except for some diarrheic episodes, he has remained well throughout the follow-up period (from June, 1999 to December, 2013). It is well known that there is no such thing as an easy diagnosis of intestinal tuberculosis, even nowadays. We have just tried to remember it.

Highlights

Intestinal involvement is a well known signature of Mycobacterium tuberculosis infection [1,2]
We describe a case of intestinal tuberculosis in a patient initially diagnosed with acute complicated appendicitis
As the surgery consultant had a strong suspicion that acute complicated appendicitis could be present, the patient was brought to the operating room for urgent intervention

Summary

Introduction

Intestinal involvement is a well known signature of Mycobacterium tuberculosis infection [1,2]. Since clinical presentation of intestinal tuberculosis (TB) usually masquerades as other conditions such as Crohns disease, malignancies, and several infectious entities, the diagnosis may become a true clinical challenge [1,3,4,5,6]. We describe a case of intestinal tuberculosis in a patient initially diagnosed with acute complicated appendicitis.

Results

Conclusion