Sare ŞİPAL, Hilmi ATASEVEN, Ömer TOPDAĞI, Ömer YILMAZ

A rare cause of malnutrition: Intestinal tuberculosis

Tüberkülozun ekstrapulmoner manifestasyonları nadirdir. İntestinal tüberküloz (İTB) nadirolmasına rağmen tanı konmadığı zaman hayatı tehdit edebilir. Spesifik bulgu ve semptomlarınınolmamasından dolayı İTB nin tanısı zor olabilmektedir. Yirmi yedi yaşında kadın hasta 6 aydırsüren karın ağrısı, ateş ve kilo kaybı şikayetleriyle kliniğimize kabul edildi. Kolonoskopi yapıldı.Kolonoskopide terminal ileum ve çekumda mokuzal lezyonlar tespit edildi. Kolonoskopidedeforme ileoçekal valv, striktürler, mukozal nodüller tespit edildi. Aktif lezyonlardan çok sayıdabiyopsiler alındı. Biyopside aside dirençli basil ve epiteloid granumlar görüldü. Hastaya İTB tanısıkonuldu. Bir yıl sürmesi planlanan dörtlü anti-TBC ilaç tedavisi başlandı. Hasta her hangi birkomplikasyon olmadan iki ay sonra taburcu edildi. İTB tamamen tedavi edilebilir bir hastalıktır.

Malnütrisyonun nadir bir nedeni: İntestinal tüberküloz

Extrapulmonary manifestations of tuberculosis are an uncommon. Intestinal tuberculosis (ITB) israre, but it remains a life-threatening disease unless diagnosed. Due to the lack of specific signsand symptoms, diagnosis of ITB can be difficult. A 27-year-old Turkish woman was admitted toour clinic with a 6-month history of abdominal pain, fever and weight loss. Colonoscopy wasperformed. At colonoscopy, there was detected in the mucosal lesions in the terminal ileum andcaecum. On colonoscopy, deformed ileocaecal valve, strictures in caecum and terminal ileum,mucosal nodules were detected. Multiple biopsy specimens were taken from the active lesion. Thediagnosis was made by demonstration of acid-fast bacilli and epithelioid cell granulomas in thecolonoscopic biopsy specimens. The lesion was diagnosed as ITB. Quadruple therapy with anti- TBC drugs for 1 year was ordered. The patient was discharged from hospital two months withoutany other complications. Intestinal TB is a treatable and curable illness.

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1. Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004; 120: 305-15.
2. Horvath KD, Whelan RL. Intestinal tuberculosis: Return of an old disease. Am J Gastroenterol 1998; 93: 692-6.
3. Ara C, Söğütlü G, Yildiz R, Kocak O, Işık B, Yılmaz S, Kırımlıoğlu V. Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure. J Gastrointest Surg 2005; 9: 514-7.
4. Leung VK, Law ST, Lam CW, Luk IS, Chau TN, Loke TK, Chan WH, Lam SH. Intestinal tuberculosis in a regional hospital in Hong Kong: A 10-year experience. Hong Kong Med J 2006; 12: 264-71.
5. Sato S, Yao K, Yao T, Schlemper RJ, Matsui T, Sakurai T, Iwashita A. Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients. Gastrointest Endosc 2004; 59: 362-8.
6. Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol 2006; 12: 6371-5.
7. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97: 1446-51.
8. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88: 989-99.
9. Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy 2005; 37: 351-6.
10. Horsburgh CR, Nelson AM, Blaser MJ, Smith PD, Ravdin JI, Greenberg HB, Guerrant RL. Mycobacterial disease of the gastrointestinal tract, editors. Infections of the gastrointestinal tract. 2nd ed. Philadelphia: Lippincott Williams & Wilkins 2002; 831-45.
11. Eisenach KD, Sifford MD, Cave MD, Bates JH, Crawford JT. Detection of mycobacterium tuberculosis in sputum samples using a polymerase chain reaction. Am Rev Respir Dis 1991; 144: 1160-3.
12. Peneau A, Moinard D, Berard I, Pascal O, Moisan JP. Detection of mycobacteria using the polymerase chain reaction. Eur J Clin Microbiol Infect Dis 1992; 11: 270-1.
13. Brandt MM, Bogner PN, Franklin GA. Intestinal tuberculosis presenting as a bowel obstruction. Am J Surg 2002; 183: 290-1.
14. Kim MP, Janz BA, Kasparian AS. Tuberculosis enteritis presenting as a small bowel obstruction. J Am Coll Surg 2005; 201: 478-9.
15. Polat KY, Aydınlı B, Yılmaz Ö, Aslan S, Gursan N, Öztürk G, Onbas O. Intestinal tuberculosis and secondary liver abscess. Mt Sinai J Med 2006; 73: 887-90.
16. Bhargava DK, Kushwaha AK, Dasarathy S, Shriniwas, Chopra P. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc 1992; 38: 571-4.
17. Bhargava DK, Tandon HD, Chawla TC, Shriniwas, Tandon BN, Kapur BM. Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc 1985; 31: 68-70.
18. Pulimood AB, Ramakrishna BS, Kurian G, Peter S, Patra S, Mathan VI, Mathan MM. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohns disease from tuberculosis. Gut 1999; 45: 537-41.