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- Title
COMPLICATIONS OF ANTI-TNF-ALPHA THERAPY IN A PATIENT WITH INTESTINAL TUBERCULOSIS.
- Authors
Jichitu, Alexandra; Ilie, Madalina; Sandru, Vasile; Pavel, Christopher; Dascalu, Ioana Raluca; Oprita, Ruxandra; Constantinescu, Gabriel
- Abstract
Introduction. Inflammatory bowel diseases and intestinal tuberculosis (TB) have similar clinical and endoscopic appearance, one of the main differences between those two entities being the presence of caseation necrosis as seen by the histopathological examination, which is specifically for TB. Case presentation. 35-year-old woman presented to our hospital for significant weight loss and mild anemia. Endoscopy and colonoscopy were both performed. Colonoscopy revealed multiple ulcers and important edema affecting the transverse colon, which made the colonoscope advancement impossible. Biopsies were taken from the affected segment and further investigations were made in order to exclude any enteral infections. We suspected Chron's disease so screening tests for detecting TB, HIV infections and viral chronic hepatitis were also performed in order to initiate biological treatment. Tests results came negative for any systemic or enteral infections, but QuantiFERON TB Gold test was inconclusive. As the chest-X ray revealed no lesions and the biopsy revealed chronic granulomatous colitis without caseation necrosis we decided to repeat the test, which came back negative. We started anti-TNF alpha therapy with infliximab and further evolution of the disease was favorable. Two months after the treatment initiation the patient presented to the emergency room with fever, abdominal pain and ascites fluid. CT scan was performed and multiple abscesses were also identified. The patient underwent surgery with right ileo-colectomy and ileostomy. Fragments were recovered and sent for histopathological examination. This time huge granulomas with caseation necrosis were identified, suggesting intestinal TB. Discussions. Intestinal TB represents 12% of the extra-pulmonary TB cases and the prevalence around the world is about 1-3%. From those cases, TB most frequently affects the ileo-cecum site, due to several factors such as physiological stasis, narrow lumen, the low activity of the digestion and the high prevalence of lymphoid tissue. On the other hand, isolated TB of the colon is rarely seen and represents almost 11% of all intestinal TB cases. Conclusions. Romania represents an endemic country for TB so detailed differential diagnosis should be made, especially with inflammatory bowel disease, as their treatment, more specifically biological therapy could lead to important complications, such as abscesses as it was our patient's case. Unfortunately, in this situation if it wasn't for the biological therapy that led to the aggravation of the TB, the disease would be treated as an inflammatory bowel disease and the diagnosis would be delayed even more.
- Subjects
ROMANIA; EXTRAPULMONARY tuberculosis; INFLAMMATORY bowel diseases; CROHN'S disease; COLECTOMY; THERAPEUTIC complications; TUBERCULOSIS patients; BIOTHERAPY; BRAIN abscess; IMMUNE reconstitution inflammatory syndrome
- Publication
Journal of Gastrointestinal & Liver Diseases, 2023, Vol 32, p75
- ISSN
1841-8724
- Publication type
Article