Clinical Case
Diagnostic approach of intestinal tuberculosis: Case report and literature review
Abordaje diagnóstico de la tuberculosis intestinal: Reporte de caso y revisión de la literatura
Ylse Gutiérrez-Grobea, Rita Dorantes-Herediab, Heriberto Medina-Francoc, Félix Ignacio Téllez-Ávilad,
Corresponding author
felixtelleza@gmail.com
Corresponding author at: Félix Ignacio Téllez-Ávila, Department of Endoscopy, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Vasco de Quiroga #15, Col. Seccio¿n XVI, Del. Tlalpan, Mexico City, CP 14000, Mexico. Tel.: +52 554870900; fax: +52 554870900.
Corresponding author at: Félix Ignacio Téllez-Ávila, Department of Endoscopy, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Vasco de Quiroga #15, Col. Seccio¿n XVI, Del. Tlalpan, Mexico City, CP 14000, Mexico. Tel.: +52 554870900; fax: +52 554870900.
a Gastroenterology Department, Medica Sur Clinic and Foundation, Mexico City, Mexico
b Patology Department, Medica Sur Clinic and Foundation, Mexico City, Mexico
c Department of Surgery, Section of Surgical Oncology, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Mexico City, Mexico
d Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Mexico City, Mexico
Read
17665
Timeswas read the article
2124
Total PDF
15541
Total HTML
Share statistics
array:23 [ "pii" => "S0188989314001791" "issn" => "01889893" "doi" => "10.1016/j.endomx.2014.11.002" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "148" "copyright" => "Asociación Mexicana de Endoscopia Gastrointestinal" "copyrightAnyo" => "2014" "documento" => "article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Endoscopia. 2014;26:132-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6116 "formatos" => array:3 [ "EPUB" => 96 "HTML" => 5053 "PDF" => 967 ] ] "itemSiguiente" => array:18 [ "pii" => "S0188989314001651" "issn" => "01889893" "doi" => "10.1016/j.endomx.2014.10.002" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "146" "copyright" => "Asociación Mexicana de Endoscopia Gastrointestinal" "documento" => "simple-article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Endoscopia. 2014;26:136-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11449 "formatos" => array:3 [ "EPUB" => 88 "HTML" => 10117 "PDF" => 1244 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Esófago negro: reporte de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "136" "paginaFinal" => "139" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Black esophagus: Case report" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1090 "Ancho" => 1500 "Tamanyo" => 229800 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imagen 1. Muestra el tercio medio esofágico donde se empiezan a apreciar los cambios de coloración en la mucosa del esófago de color negro en forma aislada. Imágenes 2 y 3. Se observa el tercio inferior del esófago donde es más frecuente que se vean los cambios del esófago negro, caracterizado por las áreas de mucosa negra distribuidas en forma circunferencial. Imagen 4. Se observa la unión esofagogástrica que se ve en forma típica en el esófago negro, en donde los cambios de coloración de la mucosa esofágica terminan abruptamente a este nivel.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Omar Jesus Pineda Oliva, Armando Valencia Romero, Mónica Valdivia Balbuena, Julio Cesar Soto Pérez, Marisela Díaz Oyola, Victor Cuevas Osorio, Jorge Farell Rivas, Mircea Gonzalez Villarello, Hugo Lopez Acevedo, Martha Leticia Llamas Ceras, Braulio Rafael Paredes Mendoza, Alejandra Toledo Manriquez" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Omar Jesus" "apellidos" => "Pineda Oliva" ] 1 => array:2 [ "nombre" => "Armando" "apellidos" => "Valencia Romero" ] 2 => array:2 [ "nombre" => "Mónica" "apellidos" => "Valdivia Balbuena" ] 3 => array:2 [ "nombre" => "Julio Cesar" "apellidos" => "Soto Pérez" ] 4 => array:2 [ "nombre" => "Marisela" "apellidos" => "Díaz Oyola" ] 5 => array:2 [ "nombre" => "Victor" "apellidos" => "Cuevas Osorio" ] 6 => array:2 [ "nombre" => "Jorge" "apellidos" => "Farell Rivas" ] 7 => array:2 [ "nombre" => "Mircea" "apellidos" => "Gonzalez Villarello" ] 8 => array:2 [ "nombre" => "Hugo" "apellidos" => "Lopez Acevedo" ] 9 => array:2 [ "nombre" => "Martha Leticia" "apellidos" => "Llamas Ceras" ] 10 => array:2 [ "nombre" => "Braulio Rafael" "apellidos" => "Paredes Mendoza" ] 11 => array:2 [ "nombre" => "Alejandra" "apellidos" => "Toledo Manriquez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0188989314001651?idApp=UINPBA00004N" "url" => "/01889893/0000002600000004/v4_201503131257/S0188989314001651/v4_201503131257/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S018898931400164X" "issn" => "01889893" "doi" => "10.1016/j.endomx.2014.10.001" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "145" "copyright" => "Asociación Mexicana de Endoscopia Gastrointestinal" "documento" => "simple-article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Endoscopia. 2014;26:128-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3622 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 2928 "PDF" => 644 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Prótesis metálica autoexpandible en el tratamiento de la estenosis del colédoco postrasplante de hígado en un niño. A propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "128" "paginaFinal" => "131" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Self-expandable metal stent on the treatment of a stenosis at the level of the coledoco-coledoco of a child with liver transplantation. Report of a case" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 999 "Ancho" => 995 "Tamanyo" => 58259 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La colangiografía al retirar la prótesis muestra un adecuado calibre del colédoco, que se vació al retirar el balón.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gerardo Blanco Rodríguez, Juan Manuel Blancas Valencia, Gustavo Varela Fascinetto, José Alejandro Hernández Plata, Juan Manuel Alcantar Fierros, Gustavo Teyssier Morales, Jaime Penchyna Grub" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Gerardo" "apellidos" => "Blanco Rodríguez" ] 1 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Blancas Valencia" ] 2 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Varela Fascinetto" ] 3 => array:2 [ "nombre" => "José Alejandro" "apellidos" => "Hernández Plata" ] 4 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Alcantar Fierros" ] 5 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Teyssier Morales" ] 6 => array:2 [ "nombre" => "Jaime" "apellidos" => "Penchyna Grub" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S018898931400164X?idApp=UINPBA00004N" "url" => "/01889893/0000002600000004/v4_201503131257/S018898931400164X/v4_201503131257/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Case</span>" "titulo" => "Diagnostic approach of intestinal tuberculosis: Case report and literature review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "132" "paginaFinal" => "135" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ylse Gutiérrez-Grobe, Rita Dorantes-Heredia, Heriberto Medina-Franco, Félix Ignacio Téllez-Ávila" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Ylse" "apellidos" => "Gutiérrez-Grobe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Rita" "apellidos" => "Dorantes-Heredia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Heriberto" "apellidos" => "Medina-Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "Félix Ignacio" "apellidos" => "Téllez-Ávila" "email" => array:1 [ 0 => "felixtelleza@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Gastroenterology Department, Medica Sur Clinic and Foundation, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Patology Department, Medica Sur Clinic and Foundation, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Surgery, Section of Surgical Oncology, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Mexico City, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Mexico City, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Félix Ignacio Téllez-Ávila, Department of Endoscopy, Instituto Nacional de Ciencias Médicas y Nutricio¿n Salvador Zubirán, Vasco de Quiroga #15, Col. Seccio¿n XVI, Del. Tlalpan, Mexico City, CP 14000, Mexico. Tel.: +52 554870900; fax: +52 554870900." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordaje diagnóstico de la tuberculosis intestinal: Reporte de caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 683 "Ancho" => 995 "Tamanyo" => 155781 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Right hemicolectomy with pseudotumoral lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis is an endemic disease in Mexico and in developing countries. Although it is a common infectious disease with a rising incidence, intestinal tuberculosis (ITB) is not a common presentation with a wide spectrum of clinical manifestations, simulating other diseases such as Crohn's disease or a wide range of malignant diseases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Because of the wide variety of non-specific manifestations (diarrhea, constipation, nausea, abdominal pain, abdominal mass) the correct diagnosis remains being a challenge. Molecular, histologic and endoscopic studies allow a better diagnostic approach in patients with high suspicion of ITB.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Histologic diagnosis with Ziehl–Nielsen stain shows acid-fast bacilli and granuloma, however less than 30% of biopsies show bacilli. On the other hand, real-time PCR assay in colonic tissue only has a sensitivity of 40–75%. Culture of biopsy is the gold standard however it requires 3–8 weeks to provide conclusive results.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Therefore an integral approach is important to make a correct diagnosis and initiate the proper therapy as soon as possible.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 34-year-old male was admitted to the Internal Medicine Department of Medica Sur Clinic and Foundation with a 2-month-history of unintentional weight loss of 17<span class="elsevierStyleHsp" style=""></span>kg, increase in bowel movements with loose and unformed stools, and abdominal pain in right lower quadrant. The diarrhea was associated with abdominal discomfort and it occurred up to 5 times a day. He referred non-quantified fever with afternoon predominance, and diaphoresis. He had history of an episode of pancreatitis of unknown etiology 3 years prior to this hospitalization, allergy to ceftriaxone, and a right orchiectomy for non-specified reason. He came from a rural town in Puebla state in Mexico and had a story of ingestion of non-pasteurized dairy products including milk and cheese. He denied prior contact with patients with tuberculosis and has no pets. He has family history of type 2 diabetes mellitus and one late uncle with history of non-specified cancer.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Previously he had been admitted to another Institution for diagnostic approach, where lab tests were carried out only with alterations in liver function tests with a cholestatic pattern, alkaline phosphatase (AP) 146<span class="elsevierStyleHsp" style=""></span>U/L, and gamma glutamyl transpeptidase (GGT) 163<span class="elsevierStyleHsp" style=""></span>U/L, the rest of lab tests were normal. In the same hospitalization, a thoracoabdominal CT scan was performed with finding of a tumor in right colon and cecum, with report of possible malignant characteristics, abdominal and retroperitoneal nodes and a distant lesion in lung with report of probable metastasis, the diagnosis of adenocarcinoma of the colon was given. He attended to our institution for a second opinion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On examination, blood pressure was 119/62<span class="elsevierStyleHsp" style=""></span>mmHg, the pulse 74 beats per minute, and temperature 36.4<span class="elsevierStyleHsp" style=""></span>°C. Plain chest X-rays were normal. Abdomen was painful at medium compression, and a solid, undefined, immobile, painful mass of 5–6<span class="elsevierStyleHsp" style=""></span>cm of diameter was palpable in right lower quadrant, with no signs of acute abdomen. In the Emergency Department new lab tests were performed with the next results hemoglobin 10.4<span class="elsevierStyleHsp" style=""></span>g/dL, platelets 541<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/ml, leukocytes 6.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/ml, glucose 87.5<span class="elsevierStyleHsp" style=""></span>mg/dL, creatinine 0.87<span class="elsevierStyleHsp" style=""></span>mg/dL, total proteins 6.47<span class="elsevierStyleHsp" style=""></span>g/dL, albumin 2.66<span class="elsevierStyleHsp" style=""></span>g/dL, direct bilirubin 0.11<span class="elsevierStyleHsp" style=""></span>mg/dL, alanine aminotransferase 20<span class="elsevierStyleHsp" style=""></span>U/L, aspartate aminotransferase 21<span class="elsevierStyleHsp" style=""></span>U/L, AP 125<span class="elsevierStyleHsp" style=""></span>U/L, GGT 106<span class="elsevierStyleHsp" style=""></span>U/L, lactic dehydrogenase 163<span class="elsevierStyleHsp" style=""></span>U/L.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A new CT scan was performed with finding of thickened colonic wall in ascending colon, with mediastinal, retroperitoneal adenopathies, bilateral pulmonary nodules and splenomegaly. Therefore a colonoscopy was done. A stenotic, nodular-shaped and ulcerated zone of 25<span class="elsevierStyleHsp" style=""></span>cm approximately was found, with loss of normal morphology, between terminal ileon and cecum (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>), biopsies were taken. Auramine-Rhodamine stain of the biopsies showed abundant fluorescent acid-fast bacilli (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Real-time PCR assay of the biopsies was positive for isoniazid and rifampin-sensitive <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>. Shortened, directly observed therapy strategy (DOTS) for tuberculosis with ioniazid 300<span class="elsevierStyleHsp" style=""></span>mg, rifampin 600<span class="elsevierStyleHsp" style=""></span>mg, pirazinamid 1600<span class="elsevierStyleHsp" style=""></span>mg and ethambutol 1200<span class="elsevierStyleHsp" style=""></span>mg was initiated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">One month after the treatment was initiated, he was re-admitted to the Emergency Department because of intense abdominal pain, cramps, arthralgia and myalgia. The patient had, previous to his admission, an episode of non-bloody diarrhea and vomit of gastric contents. Plain abdominal X-rays showed bowel distention and multiple gas-fluid levels, therefore a CT scan was carried out and bowel occlusion was confirmed. Open exploratory laparotomy was performed with finding of multiple peritoneal implants and an ileocecal tuberculoma; therefore open right hemicolectomy with ileo-transverse anastomosis was completed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). He remained hospitalized for 5 days for post-surgical surveillance with appropriate evolution and was discharged, to continue DOTS.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">ITB is a rare extrapulmonar variety of tuberculosis, with an increasing incidence in the last decades, specially in endemic countries such as Mexico. The diagnosis of ITB is always a challenge, and it is difficult to make the correct differential diagnosis specially with Crohn's disease and with different neoplasic diseases. The diagnostic approach, has implications in correct management and therefore in survival of patients, while ITB is a curable disease, Crohn's disease is a progressive relapsing illness, and intestine neoplasms, such as linfoma or adenocarcinoma may have an endoscopic appearence of circumferential thickening, with ulcers and fistulae formation that mimicks Crohn's disease or ITB.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although tuberculosis is a much more common disease in Mexico than Crohn's disease, incidence of inflammatory bowel disease in Mexico seems to be rising,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> probably, because it has become a more known disease and physicians suspect it more frequently, for this reason is imperative for Mexican doctors to recognize and learn to make the differential diagnosis of these diseases, particularly because ITB is a curable disease with the appropriate treatment initiated early. In this aspect, a diversity of endoscopic, histologic and biochemical criteria has been considered to diagnose correctly ITB.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Considering endoscopy, Sato et al., classify endoscopic findings in four types: type 1 showing linear ulcers with circunferential arrangement with a nodullary mucosa; type 2 showing irregular, rounded ulcers without nodules; type 3 multiple erotions limited to colon; and type 4 aphtous ulcers limited to the ileum. In this case, the patient showed type 1 findings.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> After the hemicolectomy was carried out, the macroscopic view of the surgical piece, showed stenosis of the lumen and ulcerations, with a totally modified morphology. The macroscopic view of the tuberculoma could have mimicked adenocarcinoma. In a prospective study by Chalya et al., 49.6% (127 patients) of 256 patients with abdominal tuberculosis presented with intestinal obstruction, and 82.8% of the sample underwent surgical treatment, and only 6.6% presented with an ileo-cecal mass. <a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Almost 75% of patients with intestinal obstruction present with data of malabsorption, in this case the patient only presented one episode of diarrhea at the time of the occlusion, without any other data of malabsorption.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Regarding histological diagnosis, the typical findings in tuberculosis are the large granulomas, usually larger than 200<span class="elsevierStyleHsp" style=""></span>m, multiple and confluent. And a distinctive characteristic of the granulomas in tuberculosis is the central caseiation, <a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> although the most trustworthy finding in the biopsies, is the evidence of <span class="elsevierStyleItalic">M. tuberculosis</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In this case we could observe several acid-fast bacilli present in the preparations of biopsy specimens. It is worth to mention that when the histological tests of the surgical piece of the hemicolectomy where performed, although numerous acid fast bacilli were found in Ziehl–Nielsen stain (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>a and b), the typical image of caseating necrosis and granulomas was absent, however hyalinized lymph nodes could be observed.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">On the other hand, nucleic acid amplification by PCR of <span class="elsevierStyleItalic">M. tuberculosis</span> in biopsy samples can facilitate diagnosis due to higher sensitivity and specificity than culture, and results can be obtained in 48<span class="elsevierStyleHsp" style=""></span>h instead of 6–8 weeks. This lab test can also identify potential drug resistance, such as to rifampicin or to isoniazid.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The ITB is a disease that may mimic many other diseases; therefore a correct approach is necessary for the correct diagnosis and treatment. In this case where previous tests showed a probable malignant disease, thanks to the modern technology such as PCR in the biopsy tissue the patient initiated treatment for tuberculosis a few days after the colonoscopy was performed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to undertake this article.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres453507" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec476322" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres453508" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec476321" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case presentation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-08" "fechaAceptado" => "2014-11-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec476322" "palabras" => array:4 [ 0 => "Intestinal tuberculosis" 1 => "Real-time PCR" 2 => "Auramine-Rhodamine stain" 3 => "Colonoscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec476321" "palabras" => array:4 [ 0 => "Tuberculosis intestinal" 1 => "PCR en tiempo real" 2 => "Tinción de auramina rodamina" 3 => "Colonoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis is an endemic disease in developing countries with an increasing incidence. Intestinal tuberculosis is a rare presentation in the absence of pulmonary disease and has a wide spectrum of clinical manifestations, mimicking other diseases such as Crohn's disease or neoplastic diseases; therefore the diagnosis is a challenge for physicians. A case is presented of a 34-year-old patient with vague abdominal symptoms with previous diagnosis of adenocarcinoma of the colon, who attended our medical unit for a second opinion.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La tuberculosis es una enfermedad endémica en algunos países en desarrollo con una incidencia que va en aumento. La tuberculosis intestinal es una presentación rara en ausencia de enfermedad pulmonar, y tiene un amplio espectro de manifestaciones clínicas que pueden simular otras enfermedades como enfermedad de Crohn o enfermedades neoplásicas, es por ello que representa siempre un reto diagnóstico. Describimos un caso de un paciente de 34 años con síntomas vagos con diagnóstico previo de adenocarcinoma del colon que acudió a nuestro hospital por una segunda opinión.</p></span>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 798 "Ancho" => 995 "Tamanyo" => 143563 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Colonoscopy showed loss of vascular pattern, ulcerations and a nodular mucosa.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 775 "Ancho" => 995 "Tamanyo" => 150765 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ileocecal region with stenosis, and loss of the normal morphology.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 547 "Ancho" => 1301 "Tamanyo" => 39568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fluorescent fast acid bacillum in Auramine-Rhodamine stain, (a) red and (b) green light (100×).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 683 "Ancho" => 995 "Tamanyo" => 155781 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Right hemicolectomy with pseudotumoral lesion.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 481 "Ancho" => 1301 "Tamanyo" => 223847 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(a) Ziehl–Nielsen stain that shows numerous acid-fast bacilli (100×). (b) Hematoxiline-Eosine stain with granulomatous colitis with Langhans giant cells (20×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal Tuberculosis: a diagnostic challenge – case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O. Giouleme" 1 => "P. Paschos" 2 => "M. Katsaros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e32834a9470" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol." "fecha" => "2011" "volumen" => "23" "paginaInicial" => "1074" "paginaFinal" => "1077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849904" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Sato" 1 => "K. Yao" 2 => "T. Yao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc." "fecha" => "2004" "volumen" => "59" "paginaInicial" => "362" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14997132" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiation between intestinal tuberculosis and crohn's disease in endoscopic biopsy specimens by polymerase chain reaction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.T. Gan" 1 => "Y.Q. Chen" 2 => "Q. Ouyang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2002.05686.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol." "fecha" => "2002" "volumen" => "97" "paginaInicial" => "1446" "paginaFinal" => "1451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12094863" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ileitis: when it is not Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. DiLauro" 1 => "N. Crum-Cianflone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11894-010-0112-5" "Revista" => array:6 [ "tituloSerie" => "Curr Gastroenterol Rep." "fecha" => "2010" "volumen" => "12" "paginaInicial" => "249" "paginaFinal" => "258" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20532706" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento quirúrgico de la enfermedad de Crohn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Takahashi-Monroy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Gac Med Mex." "fecha" => "2005" "volumen" => "141" "numero" => "5" "paginaInicial" => "351" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16353879" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.L. Chalya" 1 => "M.D. Mchembe" 2 => "S.E. Mshana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2334-13-270" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis." "fecha" => "2013" "volumen" => "13" "paginaInicial" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23758837" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bowel obstruction caused by intestinal tuberculosis: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Patel" 1 => "C. Ondhia" 2 => "S. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr.06.2011.4361" "Revista" => array:2 [ "tituloSerie" => "BMJ Case Rep." "fecha" => "2011" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.K. Makharia" 1 => "S. Srivastava" 2 => "P. Das" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2009.585" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol." "fecha" => "2010" "volumen" => "105" "paginaInicial" => "642" "paginaFinal" => "651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20087333" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/01889893/0000002600000004/v4_201503131257/S0188989314001791/v4_201503131257/en/main.assets" "Apartado" => array:4 [ "identificador" => "24703" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/01889893/0000002600000004/v4_201503131257/S0188989314001791/v4_201503131257/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0188989314001791?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 2 | 20 |
| 2024 October | 90 | 5 | 95 |
| 2024 September | 104 | 9 | 113 |
| 2024 August | 98 | 10 | 108 |
| 2024 July | 90 | 32 | 122 |
| 2024 June | 97 | 4 | 101 |
| 2024 May | 88 | 6 | 94 |
| 2024 April | 84 | 13 | 97 |
| 2024 March | 155 | 11 | 166 |
| 2024 February | 122 | 15 | 137 |
| 2024 January | 158 | 22 | 180 |
| 2023 December | 129 | 7 | 136 |
| 2023 November | 174 | 22 | 196 |
| 2023 October | 223 | 27 | 250 |
| 2023 September | 181 | 7 | 188 |
| 2023 August | 165 | 9 | 174 |
| 2023 July | 211 | 9 | 220 |
| 2023 June | 212 | 10 | 222 |
| 2023 May | 280 | 16 | 296 |
| 2023 April | 172 | 15 | 187 |
| 2023 March | 265 | 17 | 282 |
| 2023 February | 198 | 20 | 218 |
| 2023 January | 189 | 13 | 202 |
| 2022 December | 139 | 17 | 156 |
| 2022 November | 220 | 19 | 239 |
| 2022 October | 152 | 22 | 174 |
| 2022 September | 212 | 36 | 248 |
| 2022 August | 168 | 39 | 207 |
| 2022 July | 183 | 31 | 214 |
| 2022 June | 192 | 22 | 214 |
| 2022 May | 194 | 26 | 220 |
| 2022 April | 194 | 18 | 212 |
| 2022 March | 200 | 31 | 231 |
| 2022 February | 195 | 14 | 209 |
| 2022 January | 178 | 21 | 199 |
| 2021 December | 170 | 19 | 189 |
| 2021 November | 205 | 17 | 222 |
| 2021 October | 221 | 25 | 246 |
| 2021 September | 175 | 25 | 200 |
| 2021 August | 215 | 20 | 235 |
| 2021 July | 167 | 21 | 188 |
| 2021 June | 234 | 20 | 254 |
| 2021 May | 203 | 15 | 218 |
| 2021 April | 547 | 57 | 604 |
| 2021 March | 303 | 35 | 338 |
| 2021 February | 193 | 25 | 218 |
| 2021 January | 205 | 32 | 237 |
| 2020 December | 190 | 32 | 222 |
| 2020 November | 243 | 35 | 278 |
| 2020 October | 247 | 22 | 269 |
| 2020 September | 186 | 28 | 214 |
| 2020 August | 185 | 37 | 222 |
| 2020 July | 154 | 18 | 172 |
| 2020 June | 178 | 12 | 190 |
| 2020 May | 175 | 21 | 196 |
| 2020 April | 109 | 14 | 123 |
| 2020 March | 181 | 20 | 201 |
| 2020 February | 160 | 24 | 184 |
| 2020 January | 148 | 18 | 166 |
| 2019 December | 170 | 19 | 189 |
| 2019 November | 116 | 12 | 128 |
| 2019 October | 273 | 37 | 310 |
| 2019 September | 208 | 27 | 235 |
| 2019 August | 163 | 33 | 196 |
| 2019 July | 142 | 31 | 173 |
| 2019 June | 219 | 48 | 267 |
| 2019 May | 415 | 54 | 469 |
| 2019 April | 285 | 18 | 303 |
| 2019 March | 170 | 28 | 198 |
| 2019 February | 70 | 17 | 87 |
| 2019 January | 70 | 6 | 76 |
| 2018 December | 43 | 19 | 62 |
| 2018 November | 50 | 9 | 59 |
| 2018 October | 38 | 15 | 53 |
| 2018 September | 34 | 11 | 45 |
| 2018 August | 30 | 6 | 36 |
| 2018 July | 30 | 5 | 35 |
| 2018 June | 44 | 3 | 47 |
| 2018 May | 59 | 13 | 72 |
| 2018 April | 71 | 13 | 84 |
| 2018 March | 44 | 5 | 49 |
| 2018 February | 31 | 1 | 32 |
| 2018 January | 29 | 5 | 34 |
| 2017 December | 38 | 3 | 41 |
| 2017 November | 40 | 2 | 42 |
| 2017 October | 55 | 3 | 58 |
| 2017 September | 45 | 5 | 50 |
| 2017 August | 32 | 4 | 36 |
| 2017 July | 35 | 4 | 39 |
| 2017 June | 34 | 11 | 45 |
| 2017 May | 55 | 3 | 58 |
| 2017 April | 59 | 4 | 63 |
| 2017 March | 56 | 93 | 149 |
| 2017 February | 51 | 6 | 57 |
| 2017 January | 59 | 2 | 61 |
| 2016 December | 70 | 4 | 74 |
| 2016 November | 67 | 8 | 75 |
| 2016 October | 107 | 5 | 112 |
| 2016 September | 173 | 7 | 180 |
| 2016 August | 38 | 7 | 45 |
| 2016 July | 71 | 4 | 75 |
| 2016 June | 69 | 11 | 80 |
| 2016 May | 60 | 14 | 74 |
| 2016 April | 59 | 16 | 75 |
| 2016 March | 59 | 20 | 79 |
| 2016 February | 55 | 18 | 73 |
| 2016 January | 55 | 26 | 81 |
| 2015 December | 52 | 13 | 65 |
| 2015 November | 45 | 16 | 61 |
| 2015 October | 54 | 22 | 76 |
| 2015 September | 38 | 15 | 53 |
| 2015 August | 85 | 28 | 113 |
| 2015 July | 80 | 12 | 92 |
| 2015 June | 45 | 33 | 78 |
| 2015 May | 109 | 46 | 155 |
| 2015 April | 42 | 23 | 65 |
| 2015 March | 21 | 12 | 33 |
Show all