The diagnostic challenges in a child with intestinal tuberculosis

Abstract

Introduction: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. Case presentation: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient's food. The child's pulmonary X-ray was normal, but the mother's was suggestive for pulmonary TB. The QuantiFERON ® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O/Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. Conclusions: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

“…Various modalities contribute to GI–TB involvement, including ingestion of contaminated milk or food (primary TB), ingestion of contaminated sputum (secondary TB), hematogenous spread from a distant TB focus, or contiguous dissemination from infected neighboring foci via the lymphatic channels[ 18 , 19 ]. Given the absence of evidence of extra-abdominal TB in our case, we believe the infection to be primary gastric TB involving the peripancreatic lymph node.…”

Critical illness aspects of heatstroke: A hot topic

“…26 The cellular and surrounding microenvironment is susceptible to direct thermal damage after only a short period; interstitial changes occur after only 30 min at 40.5°C. 27…”

“…26 The cellular and surrounding microenvironment is susceptible to direct thermal damage after only a short period; interstitial changes occur after only 30 min at 40.5°C. 27 In addition to direct thermal damage, organ dysfunction may be due to hyperthermic damage rendering the intestinal barrier more permeable, allowing intestinal toxins such as bacteria, 28 endotoxin and lipopolysaccharides (LPS) 29 to enter the systemic circulation. Changes to the intestinal permeability can occur at modest temperatures, around 39°C, 30 and after a short period of hyperthermia, 1-2 h. 30 Intestinal permeability increases have been observed in humans during exertional hyperthermia.…”

Effects of a high-carbohydrate high-fat diet on liver morphology in young and old rats

“…Небольшая доля гепатоцитов подвергалась деструктивным изменениям, содержала пикнотичные ядра в светлой гомогенной цитоплазме, изредка обнаруживались мелкие прозрачные вакуоли, которые могли появиться из-за развития дистрофических изменений гепатоцитов. Подобная морфологическая картина характерна либо для гидропической (вакуолярной), либо для жировой дистрофии [7,8]. При окраске криостатных срезов печени суданом черным В лишь в единичных клетках выявлялись мелкие капли жира (рис.…”

“…Удельные объемы гепатоцитов, содержащих в цитоплазме вакуолярные включения, были наиболее выражены в группе 4 и значимо превышали показатели других исследованных групп. Гидропическая дистрофия чаще наблюдается при нарушении белкового метаболизма в печени в результате вирусного воздействия или кратковременной гипертермии [7]. Очаги клеточной инфильтрации Foci of cellular infiltratio 0,00 4 0,01 4 (0,00-0,01) 0,03 4 (0,00-0,03) 2,38 1, 2, 3 (2,38-2,38) Примечание: ВУВЖД -высокоуглеводная высокожировая диета, 1 -статистическая значимость различий по сравнению с группой 1, 2 -по сравнению с группой 2, 3 -по сравнению с группой 3; 4 -по сравнению с группой 4 при р ≤ 0,05.…”