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[Computer tomography aspects in the diagnosis of tuberculosis in the area of the abdomen and urogenital tract].

The morphologic aspect of abdominal tuberculosis are evaluated by C.T. The necrotising tuberculosis of the genitourinary tract presents course cystic lesions of fluid density. Similar morphologic criteria are seen in ileocecal tuberculosis. The peritoneal tuberculosis is characterized by large soft tissue masses of a high density which can be found in nearly all areas of the abdomen. The increased morbidity of tuberculosis in people from foreign countries living in the Federal Republic of Germany is pointed out.

Adolescent↗

[Tuberculous anal fistula in acquired immunologic deficiency syndrome].

We report here on a 36-year old, HIV-positive patient, who was sent to hospital with an anal fistula. A short time later during the course of an extensive diagnosis the anal fistula was recognized as an extrapulmonary manifestation of a miliary tuberculosis stemming from an immunodeficiency syndrome. A rapid conversion of the sputum, a normalization of the radiological findings and the absence of relapse are the results of the classic systemic fourfold therapy with myambutol, isoniazid, rifampicin and streptomycin. The danger of overlooking the fact that an anal fistula can be the clinically primary manifestation of a tuberculosis and the problems of a mixed infection within the scope of the acquired immunodeficiency syndrome are discussed. Tuberculosis as a frequent complicating infection of HIV-positive patients--often diagnosed some time before the AIDS-infection as in our patient--can be successfully cured by a high dose of intravenous pharmacotherapy, even when additional complications (parasitic stomatitis, increasing deterioration of the immunological parameters) are present. In order to show the large spectrum of the problems involved in the diagnosis, the therapy and the course of the active acquired immunodeficiency syndrome, we have focused here on the detailed description of the case report.

AIDS-Related Opportunistic Infections↗

[Synchronous intestinal, tonsillar and pulmonary tuberculosis].

OBJECTIVES: To emphasize the unusual synchronous presentation of intestinal, pulmonary and tonsillar tuberculosis in the same patient. CLINICAL CASE: A 43 years old male consults for abdominal pain and alternating episodes of diarrhoea-constipation. Based on radiologic, endoscopic and pathologic studies the diagnosis of Crohn's ileo-cecal disease is achieved and a treatment with salazosulphapyridine and corticosteroid is started. Two months later the patient presents with a tonsilar ulceration that is diagnosed as tuberculosis on biopsy material. At the same time, chest x-rays film reveal active tuberculous lesions, and tuberculous bacili are seen in the sputum. Simultaneously the intestinal disease worsens and complicates with incomplete occlusion that requires a right hemicolectomy. Pathologic study of the specimen shows evident tuberculous lesions. Specific treatment for tuberculosis is started, and the patient remains free of disease one year later. CONCLUSIONS: Due to the increase in the prevalence of tuberculous diseases, we must keep it in mind in the differential diagnosis of intestinal strictures, even though they are suggestive of Crohn's disease, and a radical surgical procedure must also be evaluated.

Adult↗

[Gastric tuberculosis: a report of 2 cases].

Two patients with gastric tuberculosis are described. The first presented toxic syndrome, multiple abdominal adenopathies, microcytic anemia and a subcardial ulcer with malignant characteristics at endoscopy. Diagnosis was based on the positivity of Ziehl-Neelsen staining and on the growth of Mycobacterium tuberculosis in the culture of the gastric mucosa. The second patient presented toxic syndrome, fever and a miliary pattern on thoracic radiography. Endoscopy demonstrated an ulcerated nodular lesion with granulomas with acid alcohol resistant bacillus being observed on biopsy. Mycobacterium tuberculosis was found in both the sputum and bronchoaspirate. The evolution of both cases was favorable with specific treatment.

Aged↗

[A case of pulmonary tuberculosis associated with tuberculous fistula of anus].

A 39-year old male visited the hospital complaining of perianal pain, swelling and redness. Under the diagnosis of an anal abscess, drainage was performed repeatedly. As the wound failed to heal and fistulae were detected, excision of entire tract was performed. On histopathological examination of the resected fistulae, caseous necrosis, Langhans giant cells, and epithelioid cell infiltration were found and diagnosed as anal tuberculosis. Chest X-ray showed cavitary lesion with infiltrative shadow in right upper lobe. Acid-fast bacilli were positive in sputum, and the diagnosis of pulmonary tuberculosis was confirmed. Anti-tuberculosis therapy was immediately started with good response to treatment. As tuberculosis of anal region is so rare recently and there is no characteristic clinical picture, it is very difficult to diagnose it pre-operatively. In some cases such as ours, pulmonary or other tuberculosis is accompanied with anal tuberculosis. Therefore, accurate diagnosis of anal tuberculosis is needed to find other tuberculosis early. As anal tuberculosis is rarely diagnosed correctly before operation on the basis of the clinical picture, the histopathological examination of the excised fistula is mandatory for the correct diagnosis of anal tuberculosis.

Adult↗

[Periportal adenitis secondary to abdominal tuberculosis. A CT study].

Isolated periportal tuberculous adenitis is rare. Computed tomography (TC) is the primary modality for its detection and evaluation. Although not definitive, in the presence of an appropriate clinical history and a positive purified protein derivative test, a diagnosis of periportal tuberculous lymphadenopathy may be suggested by CT by the presence of low-density enlarged porta hepatis lymph nodes with immediate postcontrast peripheral rim enhancement.

Female↗

Concomitant ceco-appendicular and urinary tuberculosis. Description of two rare cases: physiopathological and diagnostic remarks.

Two cases of specific tubercular processes in the ceco-appendicular zone and the urinary system in men aged 25 and 30 years are described. Both patients reported abdominal pain and persistent fever that did not respond to treatment. Surgery revealed ulcerated appendix, intraperitoneal serous exudate, ascitic liquid, peritoneal ulcerocaseous nodules, and fibrous adhesions. Histological sections revealed a tubercular puchet in the ceco-appendicular zone. Subsequent x-ray test in response to reports of frequent painful urination showed specific lesions in the papillae and renal ureteral ampullae, and urine cultures were positive for Koch's bacillus. Treatment with streptomycin, followed by isoniazid, rifampicin, ethambutol, and morinamid for 2 years, was effective.

Adult↗