A Rare Cause of Bloody Defecation: A Case Report

Öz

Tuberculosis, which is mainly caused by the mammalian tubercle bacilli, Mycobacterium tuberculosis complex, is life-threatening disease transmitted from human-tohuman via the airborne route. Gastrointestinal tract (GIT) tuberculosis is usually caused by swallowing infected sputum or spread of bacilli smears to the GIT. A 36-year-old male patient presented to our outpatient clinic with a one-year history of weight loss, abdominal pain, nausea, and bloody stools for the past three months. Colonoscopy revealed giant and mucopurulent exudates in the cecum, ileocecal valve, and ileum. On histopathological examination, both ileum and ascending colon biopsies showed multiple granuloma formations with caseous necrosis and multinuclear giant cells. The Ehrlich-Ziehl-Neelsen histochemical staining revealed multiple foci of acid-fast bacilli compatible with Mycobacterium tuberculosis. Chest X-ray showed bilateral infiltration of the upper zones. Acid-resistant bacilli were positive in the sputum smear test. The patient was diagnosed with GIT and pulmonary tuberculosis and appropriate treatment was initiated. This rare case highlights the importance of accurate diagnosis of tuberculosis and delayed diagnosis can cause the bacteria to infect other organs through blood, lymphatic system, or direct spread.

Anahtar Kelimeler

• Gastrointestinal tract tuberculosis
• Bloody stools
• Granuloma formations

Nadir Bir Kanlı Dışkılama Nedeni: Bir Olgu Sunumu

Öz

Esas olarak memeli tüberküloz basili olan Mycobacterium tuberculosis kompleksinin neden olduğu tüberküloz, insandan insana hava yoluyla bulaşan hayatı tehdit eden bir hastalıktır. Gastrointestinal sistem (GIT) tüberkülozu genellikle enfekte balgamın yutulması veya basil yaymalarının GIT'e yayılmasından kaynaklanır. 36 yaşında erkek hasta bir yıldır kilo kaybı, karın ağrısı, bulantı ve son üç aydır kanlı dışkılama şikayetleri ile polikliniğimize başvurdu. Kolonoskopide çekum, ileoçekal valv ve ileumda dev ve mukopürülan eksudalar görüldü. Histopatolojik incelemede hem ileum hem de çıkan kolon biyopsilerinde kazeöz nekroz ve multinükleer dev hücreli çoklu granülom oluşumları görüldü. Ehrlich-Ziehl-Neelsen histokimyasal boyaması, Mycobacterium tuberculosis ile uyumlu asit hızlı basillerin çoklu odaklarını ortaya çıkardı. Göğüs röntgeni üst bölgelerin iki taraflı infiltrasyonunu gösterdi. Balgam yayma testinde aside dirençli basiller pozitifti. Hastaya GİT ve akciğer tüberkülozu tanısı konuldu ve uygun tedavi başlandı. Bu nadir vaka, tüberkülozun doğru teşhisinin önemini vurgular ve gecikmiş teşhis, bakterilerin kan, lenfatik sistem veya doğrudan yayılma yoluyla diğer organlara bulaşmasına neden olabilir.

Anahtar Kelimeler

• Gastrointestinal sistem tüberkülozu
• Kanlı dışkı
• Granülom oluşumları

Kaynakça

1. WHO Global tuberculosis report 2020. Geneva: World Health Organization; 2020.
2. Rosado E, Penha D, Paixao P, Costa AMD, Amadora PT. Abdominal tuberculosis - Imaging findings. Educational exhibit; ECR. 2013:C–0549.
3. 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;12:264–271.
4. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis - presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005;22:685-700.
5. Tuberculosis Diagnosis and Treatment Guide, 2nd Edition Ankara, May 2019
6. Debi U, Ravisankar V, Prasad KK, et al. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol. 2014;20:14831–14840.
7. Niall O. Aston. Abdominal Tuberculosis. World Journal of Surgery. 1997;21:492–499.
8. Türkiye Cumhuriyeti Sağlık Bakanlığı Tüberküloz Tanı ve Tedavi Rehberi sayfa 105-106;2019.

9. Awasthi S, Saxena M, Ahmad F, Kumar A, Dutta S. Abdominal tuberculosis: A diagnostic dilemma. J Clin Diagn Res. 2015;9:EC01-3. doi:10.7860/JCDR/2015/13350.5887.
10. Jehangir W, Khan R, Gil C, Baruiz-Creel M, Bandel G, Middleton JR, et al. Abdominal Tuberculosis: An Immigrant's Disease in the United States. N Am J Med Sci. 2015; 7(6):247-52.
11. Gorbach SL. Infectious diarrhea and bacterial food poisoning. In: Sleisenger MH, Fordtran JS, editors. Gastrointestinal disease. Philadelphia: Saunders. 1993:1128–1161.
12. Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol. 1998;93:692–696.
13. Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol. 2002;12:312–323.
14. Rasheed S, Zinicola R, Watson D, Bajwa A, McDonald PJ. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Dis. 2007;9(9):773–783.
15. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics. 2007;27(5):1255-73. doi: 10.1148/rg.275065176.
16. Nyman RS, Brismar J, Hugosson C, Larsson SG, Lundstedt C. Imaging of tuberculosis--experience from 503 patients. I. Tuberculosis of the chest. Acta Radiol. 1996;37:482–488.
17. Lundstedt C, Nyman R, Brismar J, Hugosson C, Kagevi I. Imaging of tuberculosis. II. Abdominal manifestations in 112 patients. Acta Radiol. 1996;37:489–495.
18. Bhargava DK, Tandon HD, Chawla TC, Shriniwas BN, Kapur BM. Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc. 1985;31:68–70.
19. al-Quorain AA, Facharzt MB, al-Freihi HM, al-Gindan YM, al-Awad N. Abdominal tuberculosis in Saudi Arabia: a clinicopathological study of 65 cases. Am J Gastroenterol. 1993;88:75–79.
20. Nijhawan S, Dasarathy S, Kushwaha AK. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol. 1992;87:109–112.