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Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report

BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The...

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Autores principales: Dones, Piera, Di Gangi, Maria, Failla, Maria Concetta, Genova, Selene, Giannitto, Caterina, Corsello, Giovanni, Principi, Nicola, Esposito, Susanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219019/
https://www.ncbi.nlm.nih.gov/pubmed/25346193
http://dx.doi.org/10.1186/1756-0500-7-762
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author Dones, Piera
Di Gangi, Maria
Failla, Maria Concetta
Genova, Selene
Giannitto, Caterina
Corsello, Giovanni
Principi, Nicola
Esposito, Susanna
author_facet Dones, Piera
Di Gangi, Maria
Failla, Maria Concetta
Genova, Selene
Giannitto, Caterina
Corsello, Giovanni
Principi, Nicola
Esposito, Susanna
author_sort Dones, Piera
collection PubMed
description BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn’s disease because a misdiagnosis can have dramatic consequences. CASE PRESENTATION: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38°C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn’s disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. CONCLUSION: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems.
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spelling pubmed-42190192014-11-05 Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report Dones, Piera Di Gangi, Maria Failla, Maria Concetta Genova, Selene Giannitto, Caterina Corsello, Giovanni Principi, Nicola Esposito, Susanna BMC Res Notes Case Report BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn’s disease because a misdiagnosis can have dramatic consequences. CASE PRESENTATION: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38°C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn’s disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. CONCLUSION: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems. BioMed Central 2014-10-27 /pmc/articles/PMC4219019/ /pubmed/25346193 http://dx.doi.org/10.1186/1756-0500-7-762 Text en © Dones et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Dones, Piera
Di Gangi, Maria
Failla, Maria Concetta
Genova, Selene
Giannitto, Caterina
Corsello, Giovanni
Principi, Nicola
Esposito, Susanna
Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title_full Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title_fullStr Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title_full_unstemmed Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title_short Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
title_sort intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219019/
https://www.ncbi.nlm.nih.gov/pubmed/25346193
http://dx.doi.org/10.1186/1756-0500-7-762
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