No abstract available.
Adult ; Antineoplastic Agents/*adverse effects ; Antitubercular Agents/therapeutic use ; Biopsy ; Female ; Gastrointestinal Stromal Tumors/*drug therapy/pathology/surgery ; Humans ; Imatinib Mesylate/*adverse effects ; Lung Diseases, Interstitial/*chemically induced/diagnosis ; Mycobacterium tuberculosis/*isolation & purification ; Protein Kinase Inhibitors/*adverse effects ; Rectal Neoplasms/*drug therapy/pathology/surgery ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/diagnosis/drug therapy/*microbiology

Gastrointestinal tuberculosis that is not an unusual form of extrapulmonary tuberculosis and it is usually associated with immunocompromised condition that may present with clinical symptoms including fever, weight loss or pain. Terminal ileum and cecum are the common sites of involvement, but involvement of the stomach is rare. Furthermore, synchronous tuberculosis involving both the stomach and lower gastrointestinal tract has been reported in very few cases. Herein, we report a case of incidentally detected synchronous tuberculosis involving both the stomach and terminal ileum that was successfully treated by antituberculosis therapy in an asymptomatic immunocompetent patient.
Adult ; Antitubercular Agents/therapeutic use ; Asymptomatic Infections ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Female ; Humans ; Intestine, Small/pathology ; Stomach/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy

Obstructive jaundice caused by tuberculous lymphadenitis is a rare manifestation of tuberculosis (TB), with 15 cases having been reported in Korea. We experienced a case of obstructive jaundice caused by pericholedochal tuberculous lymphadenitis in a 30-year-old man. The patient's initial serum total bilirubin level was 21.1 mg/dL. Abdominal computed tomography revealed narrowing of the bile duct by a conglomerated soft-tissue mass involving the main portal vein. Abrupt obstruction of the common bile duct was observed on cholangiography. Pathologic analysis of a ultrasonography-guided biopsy sample revealed chronic granulomatous inflammation, and an endoscopic examination revealed esophageal varices and active duodenal ulceration, the pathology of which was chronic noncaseating granulomatous inflammation. Hepaticojejunostomy was performed and pathologic analysis of the conglomerated soft-tissue mass revealed chronic granulomatous inflammation with caseation of the lymph nodes. Tuberculous lymphadenitis should be considered in patients presenting with obstructive jaundice in an endemic area.
Adolescent ; Adult ; Bilirubin/blood ; Duodenal Ulcer/pathology ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/pathology ; Female ; Humans ; Jaundice, Obstructive/*diagnosis ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*diagnosis ; Young Adult

Tuberculosis can occur anywhere in the gastrointestinal tract. However, anorectal tuberculosis has rarely been reported. A 46-years-old male presented with abdominal pain and perianal discharge of 30 years' duration. The patient had received operations for anal fistula and inflammation three times. Although he had been taking mesalazine for the past three years after being diagnosed with Crohn's disease, his symptoms persisted. Colonoscopy performed at our hospital revealed cicatricial change of ileocecal valve and diffuse ulcer scar with mild luminal narrowing of the ascending, transverse, and descending colon without active lesions. Multiple large irregular active ulcers were observed in the distal sigmoid and proximal rectum. An anal fistula opening with much yellowish discharge and background ulcer scar was observed in the anal canal. However, cobble-stone appearance and pseudopolyposis were not present. Therefore, we clinically diagnosed him as having intestinal tuberculosis with anal fistula and prescribed antituberculosis medications. Follow-up colonoscopy performed 3 months later showed much improved multiple large irregular ulcers in the distal sigmoid colon and proximal rectum along with completely resolved anal fistula without evidence of pus discharge.
Anal Canal ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antitubercular Agents/therapeutic use ; Colon/pathology ; Colonoscopy ; Crohn Disease/diagnosis/drug therapy ; Diagnosis, Differential ; Fistula/*diagnosis/pathology ; Humans ; Ileocecal Valve/physiopathology ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Protein C/analysis ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy

OBJECTIVETo analyze the characteristics of intestinal tuberculosis(ITB) and primary small intestinal lymphoma(PSIL) in order to provide clue for the differential diagnosis.

METHODSData of 24 cases of ITB and 23 cases of PSIL confirmed by surgery and pathology were retrospectively analyzed. The clinical features, endoscopic and CT scan were compared. All the patients had complete clinical and CT data. Twenty cases of ITB and 20 PSIL had complete endoscopic data.

RESULTSITB was associated with significantly higher proportion of patients with fever(58.3% vs. 4.3%), night sweating(50.0% vs. 8.6%), pulmonary tuberculosis(54.2% vs. 4.3%) and ascites(54.2% vs. 21.7%) than PSIL(all P<0.05), and lower proportion of patients with abdominal mass (4.2% vs. 39.1%), hematochezia (8.3% vs. 47.8%), and perforation (0 vs. 39.1%)(all P<0.01). Endoscopic examination showed circumferential ulcer and rodent ulcer in 40% and 35% of the patients with ITB, and massive lesion and polypoid lesion in 55% of the patients with PSIL(P<0.05). Multi-segmental lesions, layered thickening, pneumatosis intestinalis, edematous ring, bowel lumen narrowing, hollow lymph nodes, and comb sign were more common in ITB(P<0.05), while single segmental lesions, eccentric thickening, and intussusception were more common in PSIL(P<0.05). The enhancement of intestinal wall of ITB were higher than that of PSIL(P<0.05), while the thickening and lymph nodes enlargement of PSIL were higher than that of ITB(P<0.05).

CONCLUSIONThe clinical characteristics differ between ITB and PSIL and the differential diagnosis can be made by combining endoscopy and CT.

Diagnosis, Differential ; Endoscopy ; Humans ; Intestinal Neoplasms ; diagnosis ; Intestine, Small ; pathology ; Lymphoma ; diagnosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal ; diagnosis

OBJECTIVE: We wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings. MATERIALS AND METHODS: There were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous). RESULTS: All the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases. CONCLUSION: Gallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.
Adult ; Aged ; Female ; Gallbladder Diseases/pathology/*radiography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Tuberculosis, Gastrointestinal/pathology/*radiography

Pseudomembranous colitis (PMC) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. Most cases of rifampicin-induced PMC are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. We report a case of PMC associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. A 65-year-old female patient with rectal cancer and gastrointestinal tuberculosis was admitted due to abdominal pain and diarrhea. She was treated with anti-tuberculosis agents containing rifampicin. On colonoscopic examination, mucoid exudates and yellowish plaque lesions were observed. Anti-tuberculosis agents were stopped, and the patient was treated with metronidazole. Symptoms were relieved and did not recur when all the anti-tuberculosis agents except rifampicin were started again. When a patient complains of abdominal pain or diarrhea while taking rifampicin, the physician should consider the possibility of rifampicin-associated PMC.
Aged ; Antibiotics, Antitubercular/*adverse effects/therapeutic use ; Enterocolitis, Pseudomembranous/*diagnosis/etiology/pathology ; Female ; Humans ; Rectal Neoplasms/*complications/diagnosis ; Rifampin/*adverse effects/therapeutic use ; Sigmoidoscopy ; Tuberculosis, Gastrointestinal/complications/diagnosis/*drug therapy

Tuberculosis (TB) is a still prevalent and important disease entity in Korea. TB can involve any part of the gastrointestinal tract, and intestinal TB is an important disease of extra-pulmonary TB. The diagnosis of intestinal TB remains a challenge because the signs and symptoms are nonspecific. It should be differentiated from the inflammatory bowel diseases and malignancies, especially Crohn's disease. The diagnosis of intestinal TB should be based on careful clinical evaluation, such as extra-intestinal signs, colonoscopic and histologic evaluation. Newer techniques such as PCR method or test for the diagnosis of latent TB (Interferon-gammaassay) may be helpful. In addition, a high index of suspicion must be kept in mind to ensure a timely diagnosis. Herein, IBD Study Group of the KASID proposes a diagnostic guideline based on currently available evidence and experience, especially those of Korea. We also propose the test which may be helpful to establish the proper diagnosis of intestinal TB.
Blood Chemical Analysis ; Colonoscopy ; Diagnostic Imaging ; Humans ; Interferon-gamma/analysis ; Polymerase Chain Reaction ; Tuberculosis, Gastrointestinal/*diagnosis/pathology

BACKGROUND/AIMS: The incidence of Crohn's disease (CD) has been steadily increasing in Korea due to westernized life style and widely used imaging studies such as colonoscopy. There were few studies about the status of longterm trend of CD and intestinal tuberculosis (IT). Therefore, we aimed to evaluate the trend of CD and IT in Korea. METHODS: We retrospectively reviewed the medical records of newly diagnosed 65 patients with CD and 54 patients with IT at Chonnam National University Hospital between January 1998 and August 2007. RESULTS: Between 1998 and 2002, 16 and 40 patients were newly diagnosed as having CD and IT respectively, but between 2003 and 2007, 39 and 14 patients were newly diagnosed as having CD and IT respectively. CD patients (28.2+/-15.2 years) were younger than IT (46.2+/-18.5 years) (p=0.001). The male to female ratio of CD and IT were 2:1 and 1.1:1, respectively. The most common symptom of CD and IT was abdominal pain. Longitudinal ulceration, hyperemia, luminal narrowing, pseudopolyp, and cobble stone appearance were more common in CD than in IT (p<0.05). CONCLUSIONS: While the incidence of CD has increased, the incidence of IT has fallen over the last decade.
Adolescent ; Adult ; Age Factors ; Aged ; Crohn Disease/*diagnosis/*epidemiology/pathology ; Endoscopy, Gastrointestinal ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis, Gastrointestinal/*diagnosis/*epidemiology/pathology

Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis and should be differentiated from the inflammatory bowel diseases and malignancy such as Crohn's disease, ulcerative colitis, amebic colitis, and colon cancer. Most frequently involved sites (75% of cases) are the terminal ileum and cecum. Other sites of involvement, in order of frequency, are ascending colon, jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon, and rectum. Intestinal tuberculosis simultaneously involving the stomach and colon has been very rarely reported. Recently, we experienced a case of synchronous gastric and colonic ulcers with granulomatous inflammation. Although we did not find acid fast bacilli and the culture test was negative, empirical anti-tuberculosis therapy resulted in dramatic clinical and endoscopic improvement. We report a rare case of multifocal gastrointestinal tuberculosis with a review of literature.
Colonic Diseases/*diagnosis/pathology ; Colonoscopy ; Drug Therapy, Combination ; Female ; Gastroscopy ; Humans ; Middle Aged ; Stomach Diseases/*diagnosis/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy/pathology