A child case of Down's syndrome with intestinal tuberculosis and tuberculous pleuritis

Abstract

A 13 year-old girl with Down's syndrome was admitted to our hospital with a very positive reaction to PPD 5TU, abnormal shadow on the chest X-ray films and diarrhea. She suffered from acute enterocolitis one year ago, and then has been complaining of abdominal pain, appetite loss, and weight loss for a year. After admission, she was diagnosed as tuberculous pleuritis and suspected intestinal tuberculosis by laboratory examination. She recovered without sequelae by the combination therapy of SM, INH, and RFP, and was discharged after 5 months. The diagnosis of intestinal tuberculosis was confirmed by Colon Fiberscopy showing ulceration at the ileocecal region and simultaneous biopsy showing granuloma. Surgical treatment was not reserved, because she had no complications namely perforation and fistulization. We estimated that the onset of intestinal tuberculosis coincided with the acute enterocolitis which she had about one year ago. We realized the importance of paying attention to intestinal tuberculosis in the differential diagnosis of enterocolitis, especially regional enteritis. Furthermore, in the therapy of the immunocompromised host including Down's syndrome, we must pay attention to extra-pulmonary tuberculosis. Efficiency of SM for intestinal tuberculosis with complications was confirmed.