Localized tubercular ileal perforation in a retroviral disease patient: role of conservative management

Abstract

Human immunodeficiency virus (HIV) and tuberculosis coinfection are particularly dangerous and involve high morbidity and mortality in developing countries like India. When both pathogens are simultaneously present in the patient, they decline the immunological functions and can also cause premature death. It is imperative to treat the cases judiciously to avoid complications. We present a case of a 45-year-old male with a past medical history of retroviral disease and abdominal tuberculosis. He presented to the emergency department with abdominal pain for a few days. His computed tomography (CT) scan showed a large intercommunicating collection with an air-fluid level in the epigastric region. There was a contrast leak within the collection suggestive of perforation from the ileal loop. The patient underwent ultrasonography (USG)-guided drainage along with broad-spectrum antibiotics, anti-tubercular treatment (ATT), and anti-retroviral therapy (ART). The patient recovered completely and was discharged after 4 weeks on antiretroviral and antitubercular drugs. A brief case report with a review of the literature is presented.