Introduction. Tuberculosis is a common and treatable human immunodeficiency virus-related (HIV) disease. Intestinal tuberculosis is much more recurrent in immunocompromised patients and presents as a complication of pulmonary tuberculosis due to swallow of infected sputum, hematogenic dissemination or even ingestion of contaminated milk. There is a strong need for close collaboration between HIV programmes and tuberculosis programmes.
Case presentation. A 48-year-old male patient presented for a three month history of frequent bowel movements (3-4 stools per day, without blood or mucus), a weight loss of eight kilograms, infrequent dry cough, fatigue, esophageal candidiasis, anorexia, persistent low-grade fever and intermittent pain in the right lower abdominal quadrant. Abdominal X-Ray revealed a marked dilatation of the small intestine. High resolution axial computed tomography described thickening of the terminal ileum and medial caecal wall, with slightly enlarged low density nodes. Histopathological examination of the intestinal mucosa revealed granulomatous design and caseous necrosis. The positive diagnosis was primary extrapulmonary multidrug-resistant tuberculosis with HIV infection. He received an individualized and second line antituberculous treatment combined with antiretroviral therapy. Later on, he developed pneumonia with Pneumocystis jirovecii. The patient had a good clinical response to all therapies.
Conclusions. Physicians should be aware that intestinal tuberculosis must be considered in the differential diagnosis of patients with abdominal symptoms, especially in immunocompromised patients.
Keywords: human immunodeficiency virus, extrapulmonary tuberculosis, sign of Fleischner, pneumonia with Pneumocystis jirovecii.
Petru E. MUNTEAN
Emergency Hospital of Arges County, Pitesti, Romania
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