Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review

Abstract

We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.

Primary isolated asymptomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review

“…Primary isolated gastric TB is a rare occurrence, especially without evidence of TB elsewhere. To our knowledge, for nearly 20 years, there were only two cases of isolated cardia TB, and only one case of fundus TB was reported [16][17][18]. Our case involved isolated TB in the gastric cardia without any other syndromes, except for a BMI < 16.44 kg/m 2 .…”

Primary gastric tuberculosis mimicking a submucosal tumor

“…[6,7] Isolated gastric tuberculosis is very rare with antrum being the most common site of involvement, and its endoscopic appearances are variable with both ulcers and polypoidal lesions being described. [10] The rarity of gastric involvement is due to the bactericidal nature of the gastric acid, rapid emptying of the stomach, local immunity of gastric wall and the paucity of lymphoid tissue in the gastric wall. [1,11] The most common route of infection to the stomach is spread through the adjacent celiac lymph nodes with other routes of gastric infection being a direct mucosal invasion, hematogenous spread, or extension from adjacent involved organs.…”

Primary Gastric Tuberculosis Presenting as Non-Healing Ulcer and Mimicking Crohn's Disease

“…Although direct infection through the mucosa is considered to be the most likely route in primary gastric tuberculosis (7), the routes of infection to the stomach could not be identified in the present case. Although tuberculosis usually involves the antral region, involvement of the prepy- loric region, fundus, and duodenum have been reported (7,10,11). The endoscopic appearance may be ulcerative, hypertrophic, or a combination of these findings (1,3).…”

“…Gastric tuberculosis is rare and cases of isolated gastric tuberculosis without evidence of pulmonary involvement have been reported sporadically (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Because histological confirmation of gastric tuberculosis is very difficult on endoscopic biopsies, full-thickness surgical biopsies are sometimes needed for adequate diagnostic histology (6,7).…”