11/60. Inflammatory bowel perforation during immune restoration after one year of antiretroviral and antituberculous therapy in an hiv-1-infected patient: report of a case.PURPOSE: This article reports an unusual presentation of bowel perforation. methods: We report the case of a 30-year-old HIV-infected male who suffered from an advanced state of CD4 cell depletion (29 CD4 cells per 106/l). abdominal pain and diarrhea led to further examinations. RESULTS: colonoscopy revealed a severe tuberculous ileocecal inflammation. tuberculosis and HIV infection were treated. The patient's response to antiretroviral therapy was excellent. After 11 months of potent antiretroviral treatment and 12 months of antituberculous therapy he suffered from acute abdominal pain with fever and ileus. laparotomy revealed two intestinal perforations of the jejunum and inflammation of the whole ileocecal region. CONCLUSION: Immunopathologic reactions caused by immune restoration are novel presentations of highly active antiretroviral treatment as shown here. The presented patient is an unusual case with a very late onset of inflammatory response, which led to intestinal perforation.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
12/60. Tuberculous involvement of the oesophagus with oesophagobroncheal fistula.Tuberculous involvement of the oesophagus is a rare disease. Even if it is suspected, diagnosis is often difficult though dysphagia and chest pain are the most common symptoms without any other specific signs of tuberculosis. The diagnosis is based on oesophagography, oesophagoscopy, bronchoscopy, and computed tomographic scan. Suspected tuberculosis can be confirmed with histology, smear, and culture. The two most common differential diagnoses are Crohn's disease and carcinoma. The case is reported of a female patient with tuberculous involvement of the oesophagus, who developed an oesophagobroncheal fistula during steroid treatment started for suspicion of Crohn's disease. The patient was immunocompromised due to treatment with azathioprine that she was receiving for multiple sclerosis. The fistula was successfully treated by antituberculous chemotherapy alone.- - - - - - - - - - ranking = 0.048703274868176keywords = pain, chest (Clic here for more details about this article) |
13/60. Colonic tuberculosis.Tubercle bacillus was discovered in 1882 by Robert Koch. With the introduction of chemotherapy for tuberculosis in the 1940s the incidence of this entity decreased. The incidence of the tuberculosis of the colon began to increase at the 1980s with the rise in numbers of patients considered as high risk for this entity, such as HIV-infected individuals, patients with chronic renal disease, and immunosuppressed patients with prolonged steroid therapy. We report on two patients with history of chronic abdominal pain and weight loss with a palpable mass in the right lower quadrant. In one patient chest radiography revealed a miliary reticulonodular pattern. In both, abdominal CT scan showed retroperitoneal lymphadenopathy and colonic wall thickness. Colonoscopic examination showed ulcerative lesions and ileocecal valve disruption. Microscopic examination of intestinal content showed evidenced M. tuberculosis. tuberculosis of the colon should be suspected in patients suffering from chronic abdominal pain and weight loss.- - - - - - - - - - ranking = 1.9156850072965keywords = abdominal pain, pain, chest (Clic here for more details about this article) |
14/60. A case of strongyloides stercoralis and mesenteric tuberculous infection with acute abdominal pain in an HIV-positive patient.We describe an HIV-positive female patient who had acute abdominal pain as the initial presentation of strongyloides stercoralis infection. The diagnosis was established by identifying rhabditiform larvae in stool. She also had intra-abdominal tuberculosis without intestinal perforation. To our knowledge, this is the first reported case of such a presentation.- - - - - - - - - - ranking = 4.7783028873806keywords = abdominal pain, pain (Clic here for more details about this article) |
15/60. Abdominal miliary tuberculosis in a patient with AIDS: a case report.We present a 34 year old patient, intravenous drug user, hospitalized with fever, distortion of general status, dry irritating cough, abdominal colicative pains, and we established the diagnosis of HIV infection advanced stage/AIDS; his antecedents revealed (August 2000) abdominal tuberculosis not treated during the last 3 months. He presented a pneumonia with pneumocystis carinii during hospitalization. death was due to a colon perforation with secundary peritonitis. Miliary tuberculous lesions in liver, spleen and colon were revealed at necropsy and cytomegalovirus was identified in necrotic samples also.- - - - - - - - - - ranking = 0.044339422523879keywords = pain (Clic here for more details about this article) |
16/60. Ileo-caecal tuberculosis mimicking colonic tumour--case report.A case of ileocaecal tuberculosis simulating a colonic tumour is reported. A 43 year old male patient presented with abdominal pain, weight loss, fever and right iliac fossa mass. Laboratory investigations and ultrasonography were not specific. laparotomy with ileocaecal resection was carried out and histopathological examination confirmed the diagnosis of tuberculosis.- - - - - - - - - - ranking = 0.95566057747612keywords = abdominal pain, pain (Clic here for more details about this article) |
17/60. Tuberculous gastric perforation: report of a case.A 21-year-old woman presented with a 2-day history of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed a perforation in the lesser curve of the stomach. The patient suffered a bout of hematemesis, following which an endoscopy showed a bleeding blood vessel at the edge of the perforation. We performed an emergency distal gastrectomy, including the ulcer site. Histopathological examination revealed tuberculous granulation tissue and acid-fast bacilli in the ulcer. The patient was given antituberculosis therapy (ATT) postoperatively, and was well when last seen 1 year 5 months after surgery. We analyzed the clinical data of five cases of tuberculous gastric perforation (TGP), reported between 1948 and 2003, including our patient. The patients ranged in age from 21 to 45 years, with a mean age of 36.8 years (SD /- 10.21), and a male to female ratio of 3 : 2. The diagnosis was confirmed by surgery or autopsy. Abdominal lymphadenopathy was present in all patients. gastrectomy was performed in four patients, and two were given ATT. All four patients in the previous reports died of their disease.- - - - - - - - - - ranking = 0.95566057747612keywords = abdominal pain, pain (Clic here for more details about this article) |
18/60. Disseminated nocardiosis masquerading as abdominal tuberculosis.A 32-year-old patient was admitted with a community-acquired pneumonia. She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis. While in the ward she developed an acute abdomen necessitating laparotomy, at which a diagnosis of abdominal tuberculosis was made. sputum and intraoperative pus specimens grew a multiresistant nocardia brasiliensis. Microbiological investigations for tuberculosis were negative. The patient died after a short ICU admission from multiple organ dysfunction syndrome.- - - - - - - - - - ranking = 0.0043638523442968keywords = chest (Clic here for more details about this article) |
19/60. Colonic sarcoidosis, infliximab, and tuberculosis: a cautionary tale.The antitumor necrosis factor, infliximab, has been recently shown to be effective in refractory sarcoidosis including the intestinal form of this disease. We have tried this therapy in a 55-year-old woman under immunosuppressive therapy for longstanding sarcoidosis presenting with abdominal pain apparently caused by a colonic localization of the disease. The latter diagnosis was based, as recommended, on the presence of nonnecrotizing granulomas in mucosal biopsies, the presence of systemic disease, and the careful exclusion of other granulomatous diseases, including tuberculosis. After the first IV infusion (10 mg/kg BW), she quickly improved, but the wellbeing lasted approximately 4 weeks. She then received another dose of infliximab, but she soon developed low-grade fever and weakness and shortly succumbed of miliary tuberculosis. Likely, infliximab precipitated a pre-existing mycobacterial infection of the intestine. Given the likelihood of underdiagnosing intestinal tuberculosis--and the risks associated with infliximab treatment--this case suggests that this drug should be used with extreme caution, if at all, when a diagnosis of colonic sarcoidosis is suspected.- - - - - - - - - - ranking = 0.044339422523879keywords = pain (Clic here for more details about this article) |
20/60. Left colon stenosis caused by tuberculosis.The authors present a case of intestinal tuberculosis affecting exclusively the left colon causing severe undernourishment, abdominal pain, and bowel obstruction with a sealed colonic fistula in a 10-year-old child. These clinical characteristics and difficulties led to a diagnosis of intestinal tuberculosis in childhood. Intestinal tuberculosis affecting exclusively the colon is very rare, and differential diagnosis with Crohn's disease is difficult. Surgical complications are frequent, especially intestinal obstruction, and can be treated in most cases by resection of the affected segment and primary anastomosis.- - - - - - - - - - ranking = 0.95566057747612keywords = abdominal pain, pain (Clic here for more details about this article) |
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