Abstract
Intestinal tuberculosis (TB) most commonly affects ileo-caecal region. Isolated gastric and duodenal involvement without pulmonary infection is rare. The presentation of these patients varies. Patients may present with haematemesis, non-healing chronic ulcer, mimicking malignancy, gastric perforation and gastric outlet obstruction. High degree of suspicion is needed for early diagnosis of gastro-duodenal TB. A young female patient who was being treated as a case of nonhealing chronic ulcer was referred for treatment. Histopathological examination of endoscopic biopsy specimen of the patient showed presence of granulomas composed of epitheloid cells and Langhan’s giant cells with caseation with no evidence of tuberculosis at pulmonary or other body sites. After anti-tubercular chemotherapy there was resolution of symptoms and healing of ulcers. This case of isolated gastro-duodenal TB is reported for its rarity.
 J Enam Med Col 2019; 9(3): 189-192
Highlights
Extrapulmonary tuberculosis (TB) accounts for 10– 15% of all cases of TB and the incidence reaches higher in patients with immunodeficiency.[1]
Gastro-intestinal tract (GIT) is the sixth most frequent extrapulmonary site involved by tuberculosis (TB) and ileo-caecal region is the most common site of involvement in GITTB.[2]
Four peculiarities of gastric TB described on endoscopy are — serpiginous nature of the ulcer with undermined edges, multiple fistulous openings through the mucosa and presence of superficial tubercles near the lesion.[9,11]
Summary
Extrapulmonary tuberculosis (TB) accounts for 10– 15% of all cases of TB and the incidence reaches higher in patients with immunodeficiency.[1]. A 23-year-old female student presented with complaints of pain in the upper abdomen, loss of appetite and vomiting for last 5 months. Pain was aggravated by taking meals and was occasionally reduced by taking antacid She complained of occasional vomiting which occured after taking meals. Patient complained of weakness, loss of appetite and weight loss about 7 kg in two months. Upper GI endoscopy revealed eythematous and congested mucosa of the whole stomach. Ulceration with friable mucosa and contact bleeding were seen more marked in the body and part of the fundus of the stomach (Fig 1). Patient was given four-drug anti-tubercular treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol. Follow-up endoscopy was done two months after starting treatment. The patient was disease-free six months after treatment of primary gastric tuberculosis
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