Gastric tuberculous abscesses
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Digestive and Liver Disease 45 (2013) 263 Contents lists available at SciVerse ScienceDirect Digestive and Liver Disease j our nal ho me page: www.elsevier.com/locate/dld Image of the Month Gastric tuberculous abscesses Gérard Thiéfin a,∗ , Roland Jaussaud b a Department of Hepato-Gastroenterology, Reims University Hospital, Avenue du General Koenig, 51100 Reims, France b Department of Internal Medicine and Infectious Diseases, Reims University Hospital, Avenue du General Koenig, 51100 Reims, France a r t i c l e i n f o Article history: Received 11 July 2012 Accepted 5 September 2012 Available online 9 October 2012 Fig. 1. A 27-year-old African male, recently immigrated to France as a war refugee from Sudan presented with abdominal pain and severe cachexia. Clinical examination of the abdomen was nor- mal. Laboratory tests showed microcytic anaemia and lymphopenia with elevated inflammatory markers. Serology for Human Immu- nodeficiency Virus (HIV) was negative. A computed tomography of the abdomen revealed hypodense collections in the gastric wall (Fig. 1, white arrows). Upper endoscopy showed several sessile, polypoid lesions in the gastric corpus, 1–3 cm in diameter. Lesion biopsies resulted in evacuation of a caseous material into the gastric lumen (Fig. 2). Direct examination of the material was negative for microorganisms but culture in specific medium confirmed the pres- ence of Mycobacterium tuberculosis. The patient was diagnosed with gastric tuberculous abscesses; further investigations showed pul- monary and peritoneal tuberculosis. The patient was successfully treated with a 12-month antituberculosis treatment. Epidemiology of tuberculosis in Western Europe is charac- terised by a high proportion of cases occurring in immigrants ∗ Corresponding author. Tel.: +33 3 26 78 72 29; fax: +33 3 26 78 40 61. E-mail addresses: gthiefi[email protected] (G. Thiéfin), [email protected] (R. Jaussaud). Fig. 2. from endemic countries, as illustrated by our observation, and immunocompromised patients, particularly those with HIV infec- tion. Extrapulmonary tuberculosis accounts for about 20% of all cases. Tuberculous involvement of the gastrointestinal tract is com- mon in the ileocaecal region due to richness of the lymphoid tissue, whereas gastric tuberculosis is uncommon, accounting for only 0.5–3% of all cases [1]. Reference [1] Gupta V, Goel MM, Noushif M, et al. Primary gastric tuberculosis mim- icking gastrointestinal stromal tumor. American Journal of Gastroenterology 2012;107:1269–70. 1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2012.09.001
Transcript of Gastric tuberculous abscesses
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Digestive and Liver Disease 45 (2013) 263
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease
j our nal ho me page: www.elsev ier .com/ locate /d ld
mage of the Month
astric tuberculous abscesses
érard Thiéfina,∗, Roland Jaussaudb
Department of Hepato-Gastroenterology, Reims University Hospital, Avenue du General Koenig, 51100 Reims, FranceDepartment of Internal Medicine and Infectious Diseases, Reims University Hospital, Avenue du General Koenig, 51100 Reims, France
r t i c l e i n f o
rticle history:eceived 11 July 2012ccepted 5 September 2012vailable online 9 October 2012
Fig. 1.
A 27-year-old African male, recently immigrated to France as war refugee from Sudan presented with abdominal pain andevere cachexia. Clinical examination of the abdomen was nor-al. Laboratory tests showed microcytic anaemia and lymphopeniaith elevated inflammatory markers. Serology for Human Immu-odeficiency Virus (HIV) was negative. A computed tomography ofhe abdomen revealed hypodense collections in the gastric wallFig. 1, white arrows). Upper endoscopy showed several sessile,olypoid lesions in the gastric corpus, 1–3 cm in diameter. Lesioniopsies resulted in evacuation of a caseous material into the gastric
umen (Fig. 2). Direct examination of the material was negative foricroorganisms but culture in specific medium confirmed the pres-
nce of Mycobacterium tuberculosis. The patient was diagnosed withastric tuberculous abscesses; further investigations showed pul-onary and peritoneal tuberculosis. The patient was successfully
reated with a 12-month antituberculosis treatment.Epidemiology of tuberculosis in Western Europe is charac-
erised by a high proportion of cases occurring in immigrants
∗ Corresponding author. Tel.: +33 3 26 78 72 29; fax: +33 3 26 78 40 61.E-mail addresses: [email protected] (G. Thiéfin),
[email protected] (R. Jaussaud).
[
590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevierttp://dx.doi.org/10.1016/j.dld.2012.09.001
Fig. 2.
from endemic countries, as illustrated by our observation, andimmunocompromised patients, particularly those with HIV infec-tion. Extrapulmonary tuberculosis accounts for about 20% of allcases. Tuberculous involvement of the gastrointestinal tract is com-mon in the ileocaecal region due to richness of the lymphoid tissue,whereas gastric tuberculosis is uncommon, accounting for only0.5–3% of all cases [1].
Reference
1] Gupta V, Goel MM, Noushif M, et al. Primary gastric tuberculosis mim-icking gastrointestinal stromal tumor. American Journal of Gastroenterology2012;107:1269–70.
Ltd. All rights reserved.
