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ENFLAMATUAR BARSAK HASTALIĞINI TAKLİT EDEN İNTESTİNAL TÜBERKÜLOZ OLGUSU

Year 2008, Volume: 22 Issue: 2, 51 - 54, 01.10.2008

Abstract

Tüberküloz; tüm dünyada insidansı halen artmakta olan önemli bir sağlık sorunudur. Tüberkülozlu hastaların yaklaşık %1'i intestinal tüberkülozdur. Ancak tüberküloz insidansının artışı ile birlikte intestinal tüberkülozun da daha sık görüleceği belirtilmektedir. İntestinal tüberkülozun, başlıca enflamatuar barsak hastalıkları olmak üzere pek çok hastalıkla klinik benzerlik göstermesi nedeniyle tanısı zordur. Kırkdört yaşında kadın hasta birbuçuk aydır devam eden ishal, karın ağrısı, halsizlik, kilo kaybı yakınması ile gastroenteroloji kliniğine başvurmuş. Crohn hastalığı ön tanısı ile izlenen hastanın kolonoskopisinde ileoçekal bölgede enflamatuar barsak hastalığı ile uyumlu ülserasyonlar saptanmış. Akciğer radyogramında kaviter lezyon saptanması üzerine sevk edilen olgunun balgam direkt bakısında asidorezistan basil (ARB) saptandı ve kültüründe Mycobacterium tuberculosis üredi. Aktif akciğer tüberkülozu tanısı alan hastanın kolonoskopik biyopsi preperatları intestinal tüberküloz ile uyumlu olarak değerlendirildi. Aktif akciğer tüberkülozu ve intestinal tüberküloz tanıları ile antitüberküloz tedavi başlandı. Olgumuzda akciğer tüberkülozu saptanması intestinal tüberküloz tanısını kolaylaştırmıştır. Ancak sadece intestinal bulguları olan olgularda Crohn hastalığı düşünülerek verilen steroid ve immünomodülatör tedavi hastalığın progresyonuna neden olabilir. Bu nedenle sadece kolonoskopik muayene değil, yanı sıra histopatolojik inceleme, akciğer radyogramı ve tüberkülin deri testinin birlikte değerlendirilmesi intestinal tüberküloz tanısı için önemlidir.

References

  • World Health Organization. Global tubercu- losis control: surveillance, planning, financing. WHO Report 2004. Geneva Switzerland. ISBN 4 156264 1.
  • Sibartiea V, Kirwanb WO, O’Mahonya S. Intestinal tuberculosis mimicking Crohn’s disease:lessons relearned in a new era. Eur J Gastroenterol Hepatol 19: 2007; 347–9.
  • J Cai, F Li, W Zhou, H-S Luo. Ileocecal Ulcer in Central China: Case Series. Dig Dis Sci, C Springer Science+Business Media, Inc. 2006.
  • Wong WM, Lai K-C, Yiu W-C. Intestinal tuberculosis mimicking fistulizing Crohn’s disease. Journal of Gastroenterology and Hepatology 22: 2007; 137-9.
  • Parashar K, Kyawhla S, Booth IW, et al. Ileocolic ulceration: a long-term complication following ileocolic anastomosis. J Pediatr Surg 23: ; 226-8. Yamasaki T, Sugito M, Yoshikawa I, et al. Ileocecal ulcer caused by hemotherapy. Gastrointest Endosc 55: 2002; 411.
  • Brohee G. Crohn’s disease and intestinal tuberculosis. Acta Gastroenterol Belg 1950; : 1091-105.
  • Zhou ZY, Luo HS. Differential diagnosis between Crohn’s disease and intestinal tuberculosis in China. Int J Clin Pract 60: ; 212-4. Anand BS, Schneider FE, El-Zaatari FA, et al. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 89: ; 2248-9.
  • Marshall JB. Tuberculosis of the gastrointes- tinal tract and peritoneum. Am J Gastroenterol : 1993; 989-99. return of an old disease. Am J Gastroenterol : 1998; 692-6.
  • Al Karawi MA, Mohamed AE, Yasawy MI, et al. Protean manifestations of gastrointestinal tuberculosis. Report on 130 patients. J Clin Gastroenterol 20: 1995; 225-32. Yazıflma Adresi: Dr. Yelda VAROL
  • Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Arafltırma Hastanesi, Göğüs Hastalıkları Kliniği, Yeniflehir / İZMİR Tel: 0 232 433 33 33 e-posta: yeldavatansever@hotmail.com

A CASE OF INTESTINAL TUBERCULOSIS MIMICKING INFLAMMATORY BOWEL DISEASES

Year 2008, Volume: 22 Issue: 2, 51 - 54, 01.10.2008

Abstract

Tuberculosis is an important health issue with a rising incidance all around the world. Nearly 1% of the tuberculosis patients are intestinal tuberculosis (IT). It is predicted that IT prevalance will increase along with the rise of tuberculosis prevalence. The diagnosis of IT is difficult because it mimics many other disorders especially inflammatory bowel diseases. A fourty four year old woman patient applied to a gastroenterology clinic with the symptoms of diarhea, abdomen pain, weight loss, debility lasting for an one and half month. She went through colonoscopy with the pre-diagnosis of Crohn's Disease and colonoscopy revealed inflammation in her iliocecum concordant with inflammatory bowel disease. The case was further investigated upon the upper lobe cavitary lesion in chest radiography suggestive of TB, acidoresistant bacillus (ARB) was determined in the direct sputum microscopy and Mycobacterium tuberculosis proliferated in the sputum culture. The colonoscopic biopsies of the patient who was diagnosed as pulmonary tuberculosis had the typical formations of IT. Antituberculosis treatment according to the diagnosis of lung and intestinal tuberculosis was started. In our case, determination of the lung tuberculosis facilitated the diagnosis of intestinal tuberculosis. But the patients who only have abdominal symptoms may have the risk to be treated like inflammatory bowel disease with steroids and immunomodulator therapy which might cause a progression of the disease. As a conclusion we think that evaluation of the histopathological examination, chest radiography and tuberculin skin testing along with the colonoscopy contributes significantly to the diagnosis of intestinal tuberculosis.

References

  • World Health Organization. Global tubercu- losis control: surveillance, planning, financing. WHO Report 2004. Geneva Switzerland. ISBN 4 156264 1.
  • Sibartiea V, Kirwanb WO, O’Mahonya S. Intestinal tuberculosis mimicking Crohn’s disease:lessons relearned in a new era. Eur J Gastroenterol Hepatol 19: 2007; 347–9.
  • J Cai, F Li, W Zhou, H-S Luo. Ileocecal Ulcer in Central China: Case Series. Dig Dis Sci, C Springer Science+Business Media, Inc. 2006.
  • Wong WM, Lai K-C, Yiu W-C. Intestinal tuberculosis mimicking fistulizing Crohn’s disease. Journal of Gastroenterology and Hepatology 22: 2007; 137-9.
  • Parashar K, Kyawhla S, Booth IW, et al. Ileocolic ulceration: a long-term complication following ileocolic anastomosis. J Pediatr Surg 23: ; 226-8. Yamasaki T, Sugito M, Yoshikawa I, et al. Ileocecal ulcer caused by hemotherapy. Gastrointest Endosc 55: 2002; 411.
  • Brohee G. Crohn’s disease and intestinal tuberculosis. Acta Gastroenterol Belg 1950; : 1091-105.
  • Zhou ZY, Luo HS. Differential diagnosis between Crohn’s disease and intestinal tuberculosis in China. Int J Clin Pract 60: ; 212-4. Anand BS, Schneider FE, El-Zaatari FA, et al. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 89: ; 2248-9.
  • Marshall JB. Tuberculosis of the gastrointes- tinal tract and peritoneum. Am J Gastroenterol : 1993; 989-99. return of an old disease. Am J Gastroenterol : 1998; 692-6.
  • Al Karawi MA, Mohamed AE, Yasawy MI, et al. Protean manifestations of gastrointestinal tuberculosis. Report on 130 patients. J Clin Gastroenterol 20: 1995; 225-32. Yazıflma Adresi: Dr. Yelda VAROL
  • Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Arafltırma Hastanesi, Göğüs Hastalıkları Kliniği, Yeniflehir / İZMİR Tel: 0 232 433 33 33 e-posta: yeldavatansever@hotmail.com
There are 10 citations in total.

Details

Other ID JA47AT66UC
Journal Section Case Report
Authors

Yelda Varol This is me

Atike Demir This is me

Zeynep Başer This is me

Serhan Olcay This is me

Şevket Dereli This is me

Nur Yücel This is me

Rıfat Özacar This is me

Publication Date October 1, 2008
Published in Issue Year 2008 Volume: 22 Issue: 2

Cite

APA Varol, Y., Demir, A., Başer, Z., Olcay, S., et al. (2008). ENFLAMATUAR BARSAK HASTALIĞINI TAKLİT EDEN İNTESTİNAL TÜBERKÜLOZ OLGUSU. İzmir Göğüs Hastanesi Dergisi, 22(2), 51-54.