Ewha Med J.  2015 Oct;38(3):112-116. 10.12771/emj.2015.38.3.112.

Acquired Immunodeficiency Syndrome Presenting with Abdominal Tuberculosis

• Koh BS
• Kim SJ
• Yoo KH
• Lee KH
• Noh GT
• Heo WS

• KMID: 2171347
• DOI: http://doi.org/10.12771/emj.2015.38.3.112

Abstract

The incidence of tuberculosis (TB) had gradually been declining all over the world, but in recent years, TB has been increasing due to the spread of the human immunodeficiency virus (HIV). When immune-suppression status deteriorates further, extrapulmonary TB generally appears more often. Abdominal TB is one type of extra-pulmonary TB, which may involve the gastrointestinal tract, peritoneum, lymph nodes or solid viscera. We encountered a case who had initially been diagnosed as having abdominal TB, had progressed to acute respiratory distress syndrome and was eventually confirmed as having developed acquired immune deficiency syndrome. In cases of coinfection of TB and HIV, it is reported that immunological responses become poor and complications with higher morbidity frequently occur. Therefore, the Korean guidelines for TB should be revised to ensure whether HIV infection exists in TB patients.

Keyword

Tuberculosis; HIV

MeSH Terms

Acquired Immunodeficiency Syndrome*
Coinfection
Gastrointestinal Tract
HIV
HIV Infections
Humans
Incidence
Lymph Nodes
Peritoneum
Respiratory Distress Syndrome, Adult
Tuberculosis*
Viscera

Figure

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  Fig. 1 Initial colonoscopic examination. (A, B) Deep and wide ulcerative lesions with irregular margin are observed on the terminal ileum. (C, D) An oval shaped elevated lesion with normal looking mucosa is observed on the ascending colon. The surface mucosal defect is considered as the orifice.

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  Fig. 2 Tissue biopsy findings. (A) Chronic granulomatous inflammation with caseous necrosis is observed (H&E, ×100) (B) AFB are observed on an AFB stain (×400).

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  Fig. 3 Abdominal computed tomography (CT) findings, sagittal plane (A, B) and transverse plane (C) views. The CT scan shows a thickened terminal ileum, enlargement of multiple lymph nodes and a cold abscess (arrows).

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  Fig. 4 Follow-up colonoscopic examination. (A-C) Ulcerative lesions on the terminal ileum has healed and whitish scars are observed. (D) The orifice and elevated lesion on the ascending colon have disappeared (circle).

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