A166 ABDOMINAL TUBERCULOSIS COMPLICATED BY GASTROINTESTINAL PERFORATION: A CASE REPORT
Notice bibliographique
Résumé
Abdominal tuberculosis is a rare disease in North America, and the nonspecific presentation poses diagnostic and treatment challenges. A high degree of clinical suspicion is required to make the diagnosis. Abdominal TB in itself has several different manifestations and can present as intra-abdominal lymphadenopathy, peritoneal TB, gastrointestinal tract TB, or solid organ TB (primarily liver and spleen). We present the case of a renal transplant patient with an ileal perforation while on anti-TB treatment for ileo-cecal TB. Abdominal tuberculosis should be considered in the differential diagnosis during the histopathologic evaluation in immunocompromised patients such as renal transplant recipients. Case report and literature review. A 62-year-old Pilipino female with a history of end stage renal disease and a remote renal transplant was referred to our emergency department for significant unintentional weight loss of (57 kg deficit from baseline) and cyclical febrile illness. Medications included tacrolimus and mycophenolate. Physical examination demonstrated profound cachexia with a body mass index (BMI) of 16.5 and mild right upper quadrant tenderness. Initial laboratory and infectious workup was non-contributory. Abdominal computed tomography (CT) demonstrated a soft tissue mass at the porta hepatis region and diffuse lymphadenopathy and thickening of the terminal ileum. Colonoscopy established multiple aphthous ulcers, a patulous ileo-cecal valve, necrotic tissue in the terminal ileum and a small fistulous tract in the cecum with a clear patent opening. Biopsies were taken, which revealed small-intestinal type mucosa with reactive changes, focal erosions, underlying lympho-histiocytic infiltrate without granulomas, as well as a positive Ziehl-Neelsen stain for acid-fast bacilli. Based on these findings, the final diagnosis of intestinal tuberculous was made and antitubercular therapy was initiated. A week later, she developed drowsiness, progressive abdominal tenderness, and hypotension. A subsequent CT scan demonstrated mesenteric stranding, increasing ascites and pneumoperitoneum. Emergent laparotomy confirmed a 1.5 cm perforation proximal to the ileocecal valve. Disseminated plaques on the peritoneum as well as on the gallbladder were felt to be in keeping with abdominal tuberculosis. Despite continued anti-tubercular therapy the patient passed away secondary to multiorgan failure. This case highlights intestinal perforation as a serious and rare complication of abdominal tuberculosis which can occur even during TB treatment. In this case, a possible paradoxical reaction to TB treatment, a co-inciding C difficile infection, immunosuppression and poor nutritional status may have contributed to the intestinal perforation. CAG
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».