Ileal Ulcer Perforation Caused by Non-Tuberculous Mycobacterial Infection in HIV Infected Patient: A Case Report

Authors

  • Suthat Chottanapund Department of General Surgery, Bamrasnaradura Institute, Ministry of Public Health, Nontaburi 11000, Thailand
  • Prasong Wongtawatchai Department of General Surgery, Bamrasnaradura Institute, Ministry of Public Health, Nontaburi 11000, Thailand

Abstract

Introduction: One of the common opportunistic infections in HIV infected patients in Thailand is Mycobacterium Tuberculosis. The most common manifestation is pulmonary infection. In HIV infected patients with acute abdominal condition, gastrointestinal tuberculosis is usually one of the differential diagnoses, and sometimes can mislead the diagnosis of non-tuberculous mycobacterial (NTM) infection.

Case Report: A 36-year-old male presented at Bamrasnaradura Institute with chronic diarrhea, fever and weight lost. He was a homosexual and had had history of HIV infection for 2 years without treatment. The provisional diagnosis was chronic diarrhea with HIV infection. His stool was sent for modified acid fast staining and culture for mycobacterium. The modified acid fast staining result was positive. Gastrointestinal tuberculosis was then diagnosed and he was treated by anti-tuberculosis drugs. After four weeks of anti-tuberculosis drugs, he was started on anti-retroviral drugs. Five months after the treatment, he came back with severe abdominal pain and signs of generalized peritonitis. He underwent emergency abdominal exploration which revealed a short segment of ileal stricture, a perforated ileal ulcer 3 feet proximal to ileo-caecal valve with multiple mesenteric lymphadenopathy. Right half colectomy was performed. The patient went home seven days later without complications. Histopathological examination revealed subacute ulcerated areas with perforation in the terminal ileum. Chronic caseating granulomatous inflammation suggestive of mycobacterial infection was also found. After reviewing this patient's medical records and laboratory results, we found that his stool culture for mycobacterium on his first visit was positive for non-tuberculous mycobacterium.

Discussion: Non-tuberculous mycobacterial gastrointestinal infection can cause similar manifestations as of Mycobacterium Tuberculosis gastrointestinal infection. Stool examination for modified acid fast staining only may not be enough to give the correct diagnosis. Stool culture or stool PCR for Mycobacterium Tuberculosis should be performed to confirm the diagnosis of gastrointestinal mycobacterial infection, because the medications are different for different species of Mycobacterium.

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Published

2006-09-29

How to Cite

1.
Chottanapund S, Wongtawatchai P. Ileal Ulcer Perforation Caused by Non-Tuberculous Mycobacterial Infection in HIV Infected Patient: A Case Report. Thai J Surg [Internet]. 2006 Sep. 29 [cited 2024 Dec. 23];27(3):118-21. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242004

Issue

Vol. 27 No. 3 (2006): July - September

Section

Case Reports

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Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.