Ileocecal Tuberculosis Presenting as an Atypical Girdle Ulcer Typically Recognized as Severe, Acute-phase Intestinal Tuberculosis, Report of a Case Daisuke Yoshimura 1 , Ryosuke Nagamatsu 1 , Shohei Hamada 1 , Ryohei Mauroka 1 , Toshiaki Ochiai 1 , Takahiro Mizutani 1 , Yusuke Morita 1 , Kei Nishioka 1 , Yoji Nagasaki 1 , Kojiro Niho 1 , Risa Iwao 1 , Yusuke Kitagawa 1 , Muneki Akutagawa 1 , Seiya Kato 2 , Ryuji Kajitani 3 , Hiroshi Matsuura 3 1Division of Gastroenterology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan 2Division of Pathology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan 3Division of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan Keyword: 腸結核 , 帯状潰瘍 , 回腸潰瘍 pp.239-248
Published Date 2017/2/25
DOI https://doi.org/10.11477/mf.1403200840
  • Abstract
  • Look Inside
  • Reference

 A 60-year-old male was referred to our hospital with a three-week history of fever, weight loss, and right, lower quadrant pain. Blood testing showed marked elevation of hepatobiliary enzymes, and moderate inflammation was observed. Computed tomography revealed diffuse thickening of the terminal ileum through the cecum. A barium enema study revealed that the oral margin of the ileal ulcerative lesion was sharp and the surrounding mucosa was slightly elevated. Endoscopic examination showed a girdle-shaped, coarse, granular surface with multiple aggregated erosions surrounding the deformed ileocecal valve and ulcerations over the entire circumference of the terminal ileum. Biopsy specimens of the ulcerative lesion revealed severe inflammation with multiple epithelioid granulomas, and numerous bacilli were observed on Ziehl-Neelsen staining. The culture of the biopsy specimens detected Mycobacterium tuberculosis. X-ray and endoscopic findings did not show the typical characteristics of intestinal tuberculosis, including healed ulcer scars, mucosal atrophy, and intestinal shortening. The findings in this case were suggestive of severe, acute-phase intestinal tuberculosis.

Copyright © 2017, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院