Amanda Long, DO1, Kyley Leroy, DO1, Jessica Sterling, MD2, Kimberly Heightchew, MD1; 1Lankenau Medical Center, Wynnewood, PA; 2Main Line Gastroenterology Associates, Media, PA
Introduction: Tuberculosis (TB) is considered the great mimicker, able to infiltrate multiple organ systems in unique but non-specific ways, requiring a high clinical suspicion. From a GI perspective, TB can mimic IBD, colorectal cancer, or other GI malignancies. It is among the top 10 causes of death worldwide and it is important to recognize the multiple manifestations of this treatable disease.
Methods: A 44 y/o male with a history of congenital blindness presented to the hospital with one month of dyspnea, low grade fevers, productive cough, and 55lb unintentional weight loss. He denied travel, sick contacts, abdominal pain, change in bowel habits. He denied tobacco history, alcohol history, or family history. Vitals on presentation were remarkable for HR 127, T 100.2F. Exam was remarkable for thin male, decreased breath sounds of left lower lung, benign abdominal exam. Labs were notable for ALP 282 U/L, albumin 2.2 g/dL, WBC 11.14 K/uL, Hg 10.8 g/dL, MCV 86.1 fL, PLT 524 K/uL. Chest X-ray demonstrated a large left pleural effusion. CT showed abnormal soft tissue along the ascending colon with fat stranding, thought likely malignant by radiology, and a left upper lobe mass-like opacity with mediastinal lymphadenopathy. Leading diagnosis was metastatic colorectal cancer. Thoracentesis showed exudative effusion; cytology, culture and AFB were negative x2. Colonoscopy showed a frond-like, villous, ulcerated, partially obstructing, large mass in the ascending colon; multiple biopsies revealed no malignant cells and were non-diagnostic. Right hemicolectomy revealed an inflammatory ileocecal mass with confluent caseating granulomas, with rod-shaped beaded organisms consistent with mycobacterium tuberculosis, also seen on omental and peritoneal biopsies. He was initiated on TB therapy. Discussion: Abdominal TB comprises about 10% of extra-pulmonary TB and is often confused with IBD and colon cancer. CT is the imaging modality of choice. Confirmation is histopathological biopsy, with colonoscopy providing diagnostic biopsies ~ 80% of the time (Shah). Remarkably, abdominal TB is a medical disease that can be treated with oral medications. Surgical intervention is reserved for surgical emergencies, such as obstruction, perforation or fistulation.
Shah S, Thomas V, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut. 1992;33(3):347‐351.
Partially obstructing ascending colon mass
Disclosures: Amanda Long indicated no relevant financial relationships. Kyley Leroy indicated no relevant financial relationships. Jessica Sterling indicated no relevant financial relationships. Kimberly Heightchew indicated no relevant financial relationships.