Localized tubercular ileal perforation in a retroviral disease patient: role of conservative management
DOI:
https://doi.org/10.18203/2349-2902.isj20240192Keywords:
Tubercular perforation, Retroviral disease, HIV, Abdominal tuberculosis, Intestinal perforation, Acquired immunodeficiency syndromeAbstract
Human immunodeficiency virus (HIV) and tuberculosis coinfection are particularly dangerous and involve high morbidity and mortality in developing countries like India. When both pathogens are simultaneously present in the patient, they decline the immunological functions and can also cause premature death. It is imperative to treat the cases judiciously to avoid complications. We present a case of a 45-year-old male with a past medical history of retroviral disease and abdominal tuberculosis. He presented to the emergency department with abdominal pain for a few days. His computed tomography (CT) scan showed a large intercommunicating collection with an air-fluid level in the epigastric region. There was a contrast leak within the collection suggestive of perforation from the ileal loop. The patient underwent ultrasonography (USG)-guided drainage along with broad-spectrum antibiotics, anti-tubercular treatment (ATT), and anti-retroviral therapy (ART). The patient recovered completely and was discharged after 4 weeks on antiretroviral and antitubercular drugs. A brief case report with a review of the literature is presented.
Metrics
References
Sharma M, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004;129(4):305-15.
Carrascosa M, Salcines-Caviedes J, Corral-Mones J, Gomez-Roman J, Cano-Hoz M. Intestinal tuberculosis as first manifestation of human immunodeficiency virus (HIV)Infection, A single history snapshot. J Mycobact Dis. 2014;4:1.
Muquit S, Shah M, Abayajeewa K. A case of miliary tuberculosis presenting with bowel perforation. Emerg Med J. 2006;23(11):e62.
Acer T, Karnak İ, Ekinci S, Talim B, Kiper N, Şenocak ME. Multiple jejunoileal perforations because of intestinal involvement of miliary tuberculosis in an infant. J Pediatr Surg. 2008;43(9):e17-21.
Shiekh RA, Yasmeen S, Prindiville TP, Ruebner BH. Intestinal perforation and peritonitis in AIDS: Case series and review of literature. JK-Practitioner. 2004;11(4):248-56.
Friedenberg KA, Draguesku JO, Kiyabu M, Valenzuela JE. Intestinal perforation due to Mycobacterium tuberculosis in HIV-infected individuals: report of two cases. Am J Gastroenterol. 1993;88(4):604-7.
Aaron L, Saadoun D, Calatroni I, Launay O, Memain N, Vincent V, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10(5):388-98.
Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol. 2006;12(39):6371-5.
Moreno CA, Urbano VM, Marin JG, Zabal JM, Rivera IR, Fernandez GG, et al. Rev Esp Enferm Dig. 2009;101(8):581-2.
Chong VH, Lim KS. Gastrointestinal tuberculosis. Singapore Med J. 2009;50(6):638-45.
Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: A histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. Indian J Pathol Microbiol. 2010;53(3):418-23.
Fantry GT, Fantry LE, James SP. Chronic infections of the small intestine. Textbook of Gastroenterology. Wiley-Blackwell. 2009;1234-6.
Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV coinfection. Cold Spring Harb. Perspect Med. 2015;5(7):a017871.
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G. Tuberculosis and HIV co-infection. PLoS Pathol. 2012;8(2):e1002464.
World Health Organization. Global Tuberculosis Report 2018. Available at: https://www.who.int/ publications/i/item/9789241565646. Accessed on 12 November 2023.
Raviglione A, Sulis G. Tuberculosis 2015: burden, challenges and strategy for control and elimination. Infect Dis Rep. 2016;6570.
Aaron L, Saadoun D, Calatroni I, Launay O, Mémain N, Vincent V, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10(5):388-98.
Malikowski T, Mahmood M, Smyrk T, Raffals L, Nehra V. Tuberculosis of the gastrointestinal tract and associated viscera. J Clin Tuberc Mycobact Dis. 2018;12:1-8.
Sheikh RA, Yasmeen S, Prindiville TP, Ruebner BH. Intestinal perforation and peritonitis in aids: case series and review of the literature. JK Pract. 2019;11(4):248-56.
Palacios-Zertuche JT, Limas-Rodríguez QG, González-Cantú CM, Pérez-Salazar DA, Saldivar-Martínez DE, Munoz-Maldonado GE. Case report: intestinal tuberculosis with perforation of the colon and psoas abscess associated with Escherichia coli ESBL. Med Univ. 2016;18(72):165-8.
Shiekh RA, Yasmeen S, Prindiville TP, Ruebner BH. Intestinal perforation and peritonitis in AIDS: Case series and review of literature. JK-Practitioner. 2004;11(4):248-56.
Lazarus AA, Thilagar B. Abdominal tuberculosis. Dis Mon. 2007;53(1):32-8.
Kram HB, Shoemaker WC. Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Colon Rectum. 1990;33(12):1037-40.
Doré P, Meurice JC, Rouffineau J, Carretier M, Babin P, Barbier J, et al. Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis. Rev Pneumol Clin. 1990;46(2):49-54.
Ratnam I, Chiu C, Kandala NB, Easterbrook PJ. Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis. 2006;42(3):418-27.
Bizer LS, Pettorino R, Ashikari A. Emergency abdominal operations in the patient with acquired immunodeficiency syndrome. J Am Coll Surg. 1995;180:205-9.
Downloads
Published
How to Cite
Issue
Section
