Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report

Piera Dones, Maria Di Gangi, Maria C oncetta Failla, Selene Genova, Caterina Giannitto, Giovanni Corsello, Nicola Principi, Susanna Esposito

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn's disease because a misdiagnosis can have dramatic consequences.

CASE PRESENTATION: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38 °C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn's disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started.

CONCLUSION: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron's disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems.

Original languageEnglish
Pages (from-to)762
Number of pages1
JournalBMC Research Notes
Volume7
DOIs
Publication statusPublished - 2014

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Tuberculosis
Miliary Tuberculosis
Blood
Biopsy
Incidence
Diagnostic Errors
Mycobacterium tuberculosis
Bacterial Infections
Crohn Disease
Abdominal Pain
Tomography
Skin
Fever
Pallor
Ultrasonography
Unnecessary Procedures
Intestinal Diseases
Tuberculin Test
Sweat
Tuberculin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Dones, P., Di Gangi, M., Failla, M. C. O., Genova, S., Giannitto, C., Corsello, G., ... Esposito, S. (2014). Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report. BMC Research Notes, 7, 762. https://doi.org/10.1186/1756-0500-7-762

Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis : a case report. / Dones, Piera; Di Gangi, Maria; Failla, Maria C oncetta; Genova, Selene; Giannitto, Caterina; Corsello, Giovanni; Principi, Nicola; Esposito, Susanna.

In: BMC Research Notes, Vol. 7, 2014, p. 762.

Research output: Contribution to journalArticle

Dones, P, Di Gangi, M, Failla, MCO, Genova, S, Giannitto, C, Corsello, G, Principi, N & Esposito, S 2014, 'Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report', BMC Research Notes, vol. 7, pp. 762. https://doi.org/10.1186/1756-0500-7-762
Dones, Piera ; Di Gangi, Maria ; Failla, Maria C oncetta ; Genova, Selene ; Giannitto, Caterina ; Corsello, Giovanni ; Principi, Nicola ; Esposito, Susanna. / Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis : a case report. In: BMC Research Notes. 2014 ; Vol. 7. pp. 762.
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