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Bhut B, Ghoshal UC, Verma A. Gastric tuberculosis mimicking liver abscess - A case report. Indian J Tuberc 2020; 67:274-276. [PMID: 32553327 DOI: 10.1016/j.ijtb.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/12/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Tuberculosis of the stomach is quite rare, both as a primary or secondary infection. It has varied presentation ranging from non-specific abdominal pain and constitutional symptoms to hematemesis, gastric outlet obstruction and pyrexia of unknown origin. Here, we report a rare, interesting case of locally advanced gastric tuberculosis, which morphologically mimicked liver abscess initially in a young, immunocompetent patient presenting with fever and abdominal pain. The disease was diagnosed by GeneXpert MTB/RIF assay, and responded well to antituberculosis medication without surgery. Clinicians must bear in mind that, even in the absence of immunodeficiency, as in this case, tuberculosis can involve any site in the gastrointestinal tract and may present with a variety of presentation and infiltrating adjacent organ that might be mistaken as malignancy. This is first case report of gastric tuberculosis, which is locally advanced with adjacent liver infiltration initially thought to be left lobe liver abscess.
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Affiliation(s)
- Bhavesh Bhut
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raibareli Road, Lucknow 226014, India.
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raibareli Road, Lucknow 226014, India
| | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raibareli Road, Lucknow 226014, India
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2
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Gastric tuberculosis presenting as non healing ulcer: A case report. ACTA ACUST UNITED AC 2019; 66:502-504. [DOI: 10.1016/j.ijtb.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
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3
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Ma J, Yin H, Xie H. Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature. BMC Infect Dis 2019; 19:589. [PMID: 31277586 PMCID: PMC6612222 DOI: 10.1186/s12879-019-4225-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Backgroud Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis. Case presentation A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches. Conclusion Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.
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Affiliation(s)
- Jun Ma
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Department of Tuberculosis and Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Hongyun Yin
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Huikang Xie
- Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Pathology department, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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5
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Nasa M, Kumar A, Phadke A, Sawant P. Hematemesis: Unusual presentation of isolated gastric tuberculosis. Indian J Tuberc 2015; 63:59-61. [PMID: 27235948 DOI: 10.1016/j.ijtb.2015.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/13/2015] [Indexed: 10/22/2022]
Abstract
A 25-year-old male presented with hematemesis, epigastric pain, and melena. He had dyspepsia with significant weight loss for 3 months period. On clinical examination, he was pale with no organomegaly or lymphadenopathy. The X-ray chest was normal, and ultrasound abdomen was normal. Upper GI endoscopy revealed nodularity and ulceration along proximal part of lesser curvature of the stomach. CT scan abdomen showed thickening of lesser curvature just below gastro-esophageal junction. The biopsies were negative for malignancy. Repeat upper GI endoscopy showed a nonhealing ulcer, on repeat well biopsies taken from the base of ulcer primary gastric tuberculosis was diagnosed. It showed many epithelioid cell granulomas and multinucleated giant cells with caseous necrosis on histology. Acid-fast bacilli on Zeil Neelsen staining and TB PCR were positive for Mycobacterium tuberculosis. He was put on four-drug anti-tuberculous treatment. On follow-up, the patient gradually improved and regained weight. Repeat upper GI endoscopy done after 8 weeks showed healing of the ulcer with decrease in nodularity.
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Affiliation(s)
- Mukesh Nasa
- Consultant, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India.
| | - Arvind Kumar
- Senior Resident, Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | - Aniruddha Phadke
- Associate Professor, Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
| | - Prabha Sawant
- Professor & Head, Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai, India
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Chen Y, Wang HB, Zhou BG, Wu B, Wang H. Gastric tuberculosis misdiagnosed as a submucosal tumor: A case report. Shijie Huaren Xiaohua Zazhi 2015; 23:4289-4292. [DOI: 10.11569/wcjd.v23.i26.4289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric tuberculosis is a clinically rare disease. Due to unspecific clinical manifestations, it is easily misdiagnosed. In order to help physicians to raise their awareness of the disease and reduce misdiagnosis, we report a case of gastric tuberculosis that was misdiagnosed as a submucosal tumor. Submucosal tunnelling endoscopic resection (STER) was performed in this case.
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7
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Gastric tuberculosis with outlet obstruction: a case report presenting with a mass lesion. Case Rep Med 2013; 2013:169051. [PMID: 24082885 PMCID: PMC3776544 DOI: 10.1155/2013/169051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/24/2013] [Accepted: 08/04/2013] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis is a major health problem worldwide. In India, it is highly endemic. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocecal region being the commonest site. Gastric tuberculosis is rare and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report a case of gastric tuberculosis presenting as gastric outlet obstruction in an immunocompetent patient without evidence of pulmonary tuberculosis. Biopsy and PCR confirmed the diagnosis, and the patient responded well to standard antitubercular treatment. Though, gastric tuberculosis is rare, it should be considered as a possibility when patients present with gastric outlet obstruction, particularly in endemic areas with tuberculosis.
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8
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Gupta V, Goel MM, Noushif M, Rai P, Gupta P, Chandra A. Primary gastric tuberculosis mimicking gastrointestinal stromal tumor. Am J Gastroenterol 2012; 107:1269-70. [PMID: 22859010 DOI: 10.1038/ajg.2012.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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9
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Isolated gastric tuberculosis: a case report and review of literature. Indian J Surg 2010; 72:412-3. [PMID: 21966145 DOI: 10.1007/s12262-010-0133-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/03/2008] [Indexed: 10/18/2022] Open
Abstract
Isolated gastric tuberculosis is a rare condition, even in those parts of the world where intestinal tuberculosis is common. Herein we describe a case of a thirty year old female patient with isolated gastric tuberculosis who presented with features of gastric outlet obstruction.
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Manzelli A, Stolfi VM, Spina C, Rossi P, Federico F, Canale S, Gaspari AL. Surgical treatment of gastric outlet obstruction due to gastroduodenal tuberculosis. J Infect Chemother 2008; 14:371-3. [PMID: 18936891 DOI: 10.1007/s10156-008-0635-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 06/25/2008] [Indexed: 11/27/2022]
Abstract
Gastroduodenal tuberculosis is a very rare location of abdominal tuberculosis; it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. We report a case of a 45-year-old woman with no HIV infection and no evidence of pulmonary tuberculosis, with a history of duodenal ulcer treated for several months, who presented at the emergency department with severe gastric outlet obstruction of recent onset caused by ulcerohypertrophic antroduodenal tuberculosis. The lesion was misdiagnosed at endoscopy as a malignancy, although histological examination of biopsies showed only chronic inflammation. The diagnosis was established at surgery, when a frozen section of an enlarged lymph node showed the presence of giant cells and caseating granuloma. The treatment was gastric resection with Roux-en-Y gastrojejunal anastomosis. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement.
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Affiliation(s)
- Antonio Manzelli
- Department of Surgery, General Surgery Division, Policlinico Tor Vergata, University of Rome Tor Vergata, V le Oxford, 81 00133, Rome, Italy.
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11
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Jones MP. The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs. J Psychosom Res 2006; 60:407-12. [PMID: 16581366 DOI: 10.1016/j.jpsychores.2005.08.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Indexed: 12/30/2022]
Abstract
A variety of organic etiologies are associated with peptic ulcer disease, and the most relevant of these are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs. Between 5% and 20% of patients with gastric or duodenal ulcer, however, lack an identifiable organic etiology. In these patients particularly and in all ulcer patients in general, psychosocial factors may play a significant role. At present, there is no definitive study proving a causal relationship between psychological stress and the development of ulcer disease. Studies to date suffer from significant methodological limitations and have not effectively addressed the poor correlation between ulcer craters and ulcer symptoms. A conservative application of available data would suggest that psychosocial factors play a significant role in symptom perception and reporting in patients with dyspeptic symptoms and may play a role in ulcer formation.
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Affiliation(s)
- Michael P Jones
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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12
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Talukdar R, Khanna S, Saikia N, Vij JC. Gastric tuberculosis presenting as linitis plastica: a case report and review of the literature. Eur J Gastroenterol Hepatol 2006; 18:299-303. [PMID: 16462546 DOI: 10.1097/00042737-200603000-00013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Gastric tuberculosis is rare and usually presents as an ulcerated lesion or gastric outlet obstruction. Rarer presentations include massive gastrointestinal bleed and gastric perforation. A case of gastric tuberculosis presenting as linitis plastica is reported here. This is the first such case report. The patient was a young woman who presented with non-specific abdominal pain and significant weight loss. The gastric mucosa appeared oedematous and hyperaemic and there was spontaneous oozing of blood on upper gastrointestinal endoscopy. Computed tomography of the abdomen revealed diffuse thickening of the gastric wall. The diagnosis was confirmed by the presence of caseating granulomas with acid fast bacilli in the endoscopic biopsy specimen. The patient showed significant clinical improvement on four-drug anti-tuberculous treatment.
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Abstract
Tuberculosis of the stomach is quite rare, both as a primary or secondary infection. It can present as a facet of a multiorgan disease process or may result from immunodeficiency. Here, we report a rare, interesting case of gastric tuberculosis which morphologically mimicked advanced gastric cancer in a young, immunocompetent patient presenting with hematemesis and melena. The disease was diagnosed by biopsy, and responded well to antituberculosis medication without surgery. Clinicians must bear in mind that, even in the absence of immunodeficiency, as in this case, tuberculosis can involve any site in the gastrointestinal tract and may present with a variety of characteristics. Gastric tuberculosis should always be part of the differential diagnosis of chronic infiltrative lesions in the stomach.
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Affiliation(s)
- Seong-Eun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Su Jin Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Kwon Yoo
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
| | - Il Hwan Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Institute, Seoul, Korea
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14
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Amarapurkar DN, Patel ND, Amarapurkar AD. Primary gastric tuberculosis--report of 5 cases. BMC Gastroenterol 2003; 3:6. [PMID: 12703983 PMCID: PMC155648 DOI: 10.1186/1471-230x-3-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Accepted: 04/18/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric tuberculosis is rare, and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report five cases of gastric tuberculosis in immunocompetent patients without evidence of pulmonary involvement. CASE PRESENTATION Three patients presented with gastric outlet obstruction that required surgery to relieve the obstruction as well as to confirm the diagnosis. The remaining two had involvement of gastroesophageal junction. All of them responded well to standard antitubercular treatment. CONCLUSION Though gastric tuberculosis is rare, it should be considered a possibility when patients present with gastric outlet obstruction or with endoscopic evidence of diffuse chronic inflammatory activity, particularly in areas endemic for tuberculosis.
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Affiliation(s)
- Deepak N Amarapurkar
- Departments of Gastroenterology and Hepatology Bombay Hospital and Medical Research Centre, India
| | - Nikhil D Patel
- Departments of Gastroenterology and Hepatology Bombay Hospital and Medical Research Centre, India
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