A case of intestinal tuberculosis with AIDS diagnosed as acute abdomen

Abstract

A patient visited our department because of severe abdominal pain and a high fever, which was diagnosed as intestinal tuberculosis with AIDS after operation. A 22-year-old woman was initially admitted to our hospital because of slight abdominal pain and a high fever. She was diagnosed and treated for pyelonephritis. But her condition did not improve. Subsequently she visited our department because of severe right lower abdominal pain. Abdominal physical findings revealed muscular rigidity at the right lower abdomen. Abdominal ultrasonography showed a low-echoic lesion at the same region. Under a diagnosis suggestive of appendicitis with abscess, emergency laparotomy was performed. However, intraoperative findings revealed a tumor with mesenteric lymph node swelling at the terminal ileum. Malignant tumor was suspected. The terminal ileum was stenosed by the tumor, so ileocecal resection was carried out. Histopathological examination revealed caseation necrosis with epithelioid cell. After operation, HIV antibody was revealed as positive. After the 60th postoperative day, culture and identification test of sputum and feces for tubercle baccillus were reported as positive. Therefore, the tumor was diagnosed as intestinal tuberculosis. Inspire of treatment for tuberculosis, high fever continued. On the 25th post operative day, she was referred to another hospital for treatment of AIDS.