Gastric Tuberculosis with Outlet Obstruction: A Case Report Presenting with a Mass Lesion

Abstract

Tuberculosis is a major health problem worldwide. In India, it is highly endemic. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocecal region being the commonest site. Gastric tuberculosis is rare and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report a case of gastric tuberculosis presenting as gastric outlet obstruction in an immunocompetent patient without evidence of pulmonary tuberculosis. Biopsy and PCR confirmed the diagnosis, and the patient responded well to standard antitubercular treatment. Though, gastric tuberculosis is rare, it should be considered as a possibility when patients present with gastric outlet obstruction, particularly in endemic areas with tuberculosis.

Primary gastric tuberculosis mimicking gastric cancer

“…The diagnosis is made through the discovery of bacilli in the biopsy specimen. However, in some cases, when acidresistant bacilli cannot be identified, PCR may aid in the diagnosis (9). After finding the deposition of fluorodeoxyglucose ( 18 F-FDG) in the tissues, PET-CT has an important role in staging the malignant disease and evaluating treatment.…”

A rare case of primary gastric tuberculosis presenting as gastric outlet obstruction mimicking malignancy

“…7 The bactericidal action of gastric acid with intact gastric mucosa along with less number of lymphoid tissues in the gastric wall may account for the rare occurrence of gastric tuberculosis. 8 Isolated gastric tuberculosis may be attributed to ingestion of unpasteurized milk of animals with bovine tuberculosis or in patients with a severely immunocompromised condition. 6 Gastric tuberculosis is more common in endemic countries like India and Africa.…”

“…The risk of developing tuberculosis increases by 20-30 times in patient coinfected with HIV with an increase in extrapulmonary involvement. 8 The most common symptoms of gastric tuberculosis includes vomiting and epigastric pain with weight loss, upper gastrointestinal bleed and fever as other symptoms. 8 In this case, the patient had presented with vomiting, epigastric pain and weight loss.…”

“…The histological examination along with ZN stain and culture may aid in the definitive diagnosis. 8 PCR testing also facilitates the diagnosis. 6 However, stains for acid fast bacilli are usually negative as also seen in our case.…”

Primary gastric tuberculosis mimicking a submucosal tumor

“…Gastric tuberculosis is very rare and is usually associated with pulmonary tuberculosis. [1,2] Its clinical features closely resembles that of peptic ulcer disease or malignancy with patients usually presenting with dyspepsia or gastric outlet obstruction. [3][4][5] A submucosal bulge with the normal overlying mucosa is usually due to submucosal tumors or vascular lesions and has been rarely reported with tuberculosis.…”