Onset of tuberculosis after intestinal bypass surgery for obesity. Guidelines for evaluation, drug prophylaxis, and treatment.

The association of tuberculosis after gastrectomy is well documented. Two case reports of tuberculosis developing after jejunoileal bypass for massive obesity are presented, with a review of five previously reported cases. Four of the seven reported patients had tuberculosis infection at extrapulmonary sites. Initial symptoms included fever and acceleration of weight loss. The mean time elapsed from the time of the operation to the diagnosis of tuberculosis was 16 months. Guidelines are given for monitoring patients undergoing jejunoileal bypass with tuberculin skin tests. Indications for isoniazid prophylaxis and multiple drug chemotherapy are given. Serum concentrations of oral antituberculosis drugs must be monitored to ensure adequate absorption.