Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature

Abstract

Backgroud Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis. Case presentation A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis . Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches. Conclusion Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.

A rare case of gastric fundus tuberculosis with nonspecific abdominal pain

“…6 Gastric TB is often secondary to pulmonary TB or other extrapulmonary TB; however, the mechanism of infection is not fully understood. Four possible routes of infection have been proposed: 7 (1) direct invasion of the gastric mucosa by swallowing MTB; (2) hematogenous; (3) lymphatic; and (4) direct spread of TB in the gastric lymph nodes or peritoneum. Among these routes, the first may be more common; this is supported according to the use of gastric lavage to diagnose TB in children.…”

Esophageal Tuberculosis as a Rare Cause of Dysphagia: Case Report

“…15 Acid-fast bacilli staining on biopsied tissue has high specificity but low sensitivity for TB. 16 Instead, tissue PCR should be used, given the higher sensitivity estimated to be between 74% to 100% with most false-negatives as a result of insufficient tissue sampling. [16][17][18] The most common etiology of esophageal TB is local spread from adjacent respiratory tract or mediastinal lymph nodes.…”

“…16 Instead, tissue PCR should be used, given the higher sensitivity estimated to be between 74% to 100% with most false-negatives as a result of insufficient tissue sampling. [16][17][18] The most common etiology of esophageal TB is local spread from adjacent respiratory tract or mediastinal lymph nodes. 5,19 While our patient had no respiratory symptoms, normal chest x-ray, and negative TST, lung scarring seen on her CT chest may indicate latent pulmonary TB.…”

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

“…In the clinic, there are various manifestations of gastric TB, such as SMT, gastric carcinoma, gastric ulcers, diffuse gastric mucosal lesions, etc. The gold standard to determine the pathology is endoscopic guided biopsy, especially combined with acid-fast staining; TB-PCR, PET-CT and EUS-guided biopsy are also helpful in the diagnosis of gastric TB and its differentiation from gastric stromal tumor and gastric cancer [2,11,19,20].…”