Department of Radiology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
J Med Case Rep. 2021 Mar 31;15(1):144. doi: 10.1186/s13256-021-02752-2.
Diagnosis of intestinal tuberculosis poses a dilemma to physicians due to nonspecific symptoms like abdominal pain, fever, nausea, and a change in bowel habit. In particular, the distinction between inflammatory bowel disease and intestinal tuberculosis remains challenging.
A 27-year-old man from Colombia presented with fever, night sweats, and progressive lower abdominal pain. Computed tomography revealed a thickening of the bowel wall with a mesenterial lymphadenopathy, ascites ,and a pleural tumor mass. Histology of intestinal and pleural biopsy specimens showed a granulomatous inflammation. Although microscopy and polymerase chain reaction (PCR) for Mycobacterium tuberculosis (MTB) were negative, empirical MTB treatment was initiated on suspicion. Due to a massive post-stenotic atrophied intestinal bowel, MTB medications were administered parenterally in the initial phase of treatment to guarantee adequate systemic resorption. The complicated and critical further course included an intra-abdominal abscess and bowel perforation requiring a split stoma, before the patient could be discharged in good condition after 3 months of in-hospital care.
This case highlights the clinical complexity and diagnostic challenges of intestinal MTB infection. A multidisciplinary team of physicians should be sensitized to a timely diagnosis of this disease, which often mimics inflammation similar to inflammatory bowel disease, other infections, or malignancies. In our case, radiological findings, histological results, and migratory background underpinned the suspected diagnosis and allowed early initiation of tuberculostatic treatment.
由于腹痛、发热、恶心和排便习惯改变等非特异性症状，肠结核的诊断对医生来说是一个难题。特别是，炎症性肠病和肠结核的鉴别仍然具有挑战性。
一名来自哥伦比亚的 27 岁男性，出现发热、盗汗和进行性下腹痛。计算机断层扫描显示肠壁增厚伴肠系膜淋巴结病、腹水和胸膜肿瘤。肠和胸膜活检标本的组织学检查显示肉芽肿性炎症。尽管显微镜检查和结核分枝杆菌（MTB）聚合酶链反应（PCR）为阴性，但怀疑存在 MTB 感染，因此开始进行经验性 MTB 治疗。由于狭窄后萎缩性肠段大量存在，在治疗的初始阶段，MTB 药物通过肠外途径给药，以确保充分的全身吸收。复杂和危急的进一步病程包括腹腔脓肿和肠穿孔，需要进行分体造口术，经过 3 个月的住院治疗后，患者情况良好得以出院。
本病例强调了肠 MTB 感染的临床复杂性和诊断挑战。应提高多学科医生团队对这种疾病的诊断意识，因为该病常类似于炎症性肠病、其他感染或恶性肿瘤引起的炎症。在我们的病例中，放射学发现、组织学结果和迁移背景支持了疑似诊断，并允许早期开始抗结核治疗。
