Park Hansang, Kansara Tikal, Victoria Ana M, Boma Noella, Hong Jungrak
Internal Medicine, New York City Health and Hospitals Corporation (NYC HHC) Metropolitan, New York, USA.
Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.
Cureus. 2021 Feb 1;13(2):e13058. doi: 10.7759/cureus.13058.
Diagnosing intestinal tuberculosis (TB) with uncommon clinical manifestations is often challenging. Here, we report a case of an alcoholic patient who presented with vague symptoms and was later diagnosed with intestinal TB. This patient experienced multiorgan failure causing hemodynamic instability requiring ionotropic support; acute hypoxic respiratory failure managed with non-invasive positive pressure ventilation, hepatic failure, transudative peritoneal effusion, and transudative pleural effusion. These conditions clouded our judgment to pursue colonoscopy for a definite diagnosis and delayed the anti-tuberculosis treatment. When intestinal tuberculosis TB is suspected, the differential diagnosis must be established with other gastrointestinal involving diseases, including mycobacterium avium complex (MAC) and Crohn's disease (CD). MAC can show overlapping features with intestinal TB or coexist with it; Acid-fast stain and tissue culture are the key tests to differentiate these two. In the presence of diagnostic uncertainty between intestinal TB and CD, a therapeutic trial with anti-tuberculous therapy may be warranted.
诊断临床表现不常见的肠结核往往具有挑战性。在此，我们报告一例酒精性患者，该患者最初症状模糊，后来被诊断为肠结核。该患者出现多器官功能衰竭，导致血流动力学不稳定，需要使用血管活性药物支持；急性低氧性呼吸衰竭采用无创正压通气治疗，还出现了肝衰竭、漏出性腹腔积液和漏出性胸腔积液。这些情况干扰了我们通过结肠镜检查进行明确诊断的判断，并延误了抗结核治疗。当怀疑肠结核时，必须与其他累及胃肠道的疾病进行鉴别诊断，包括鸟分枝杆菌复合体（MAC）和克罗恩病（CD）。MAC可能表现出与肠结核重叠的特征或与之共存；抗酸染色和组织培养是区分这两者的关键检查。在肠结核和CD之间存在诊断不确定性的情况下，进行抗结核治疗的试验性治疗可能是必要的。
