title: [A surgically treated case of ileus caused by small intestinal tuberculosis during treatment for pulmonary tuberculosis].
abstract: A 44-year-old man consulted medical clinic, complaining of cough and sputum. Then he was admitted to our hospital, because of positive acid-fast bacilli in his sputum and positive PCR (polymerase chain reaction) for Mycobacterium tuberculosis. Combined use of isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA) was started. But 4 days after starting treatment, we had to suspend tuberculosis chemotherapy because of hepatopathy. Since then he started to complain epigastralgia and vomiting. Plain abdominal X-ray and abdominal computed tomography (CT) led to a diagnosis of ileus. Inspite of insertion of ileus tube symptoms of ileus did not improve. Small bowl series showed severe stenosis at ileum end, necessitating jejunectomy. Macroscopic study revealed a ring ulcer and multiple epithelioid cell granuloma with Langhans' giant cells was detected histopathologically. PCR for M. tuberculosis of extracts from ileum was positive. Therefore the patient was diagnosed small intestinal tuberculosis. Treatment was continued by the combination of INH, RFP, EB, and the symptoms markedly improved. There have been no sign of recurrence since the end of the 6-month treatment for tuberculosis.
authors.affiliation: Department of Respiratory Medicine, Toyohashi Municipal Hospital, Aichi, Japan. norihiko@mva.biglobe.ne.jp
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ida
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Gonda
authors.forename: Takashi
authors.initials: T
authors.lastname: Oishi
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Suganuma
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yamaguchi
authors.forename: Keiko
authors.initials: K
authors.lastname: Kinoshita
authors.forename: Ryujiro
authors.initials: R
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage; D004977:Ethambutol / Q000008:administration & dosage; D006801:Humans; D007077:Ileal Diseases / Q000150:complications*; D045823:Ileus / Q000601:surgery*; D007538:Isoniazid / Q000008:administration & dosage; D008297:Male; D011718:Pyrazinamide / Q000008:administration & dosage; D012293:Rifampin / Q000008:administration & dosage; D014385:Tuberculosis, Gastrointestinal / Q000150:complications*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin