title: Intestinal tuberculosis complicated with perforation during anti-tuberculous treatment in a 13-year-old girl with defective mitogen-induced IL-12 production.
abstract: Interleukin-12 (IL-12) is a cytokine which is secreted by activated phagocytes and dendritic cells and promotes cell-mediated immunity to intracellular pathogens, by inducing type 1 helper T cell (TH1) responses and interferon- γ (IFN- γ) production. Defects in the IL-12 may cause selective susceptibility to intracellular pathogens, such as mycobacteria. We herein report on a 13-year-old girl with defective mitogen-induced IL-12 production, who developed intestinal tuberculosis with wide dissemination involving the lung and urinary tract. She improved gradually, but developed terminal ileal perforation approximately 6.1 months following initiation of anti-tuberculous treatment. The paradoxical response phenomenon was suspected. The girl subsequently underwent surgical resection of the affected bowel segment with a temporary double barrel stoma, and ileocolonic anastomosis was performed after the completion of the anti-tuberculous therapy. The patient remained well, with no evidence of recurrent tuberculosis in the past 5 years. This case illustrates the possibility of underlying primary immunodeficiency in a patient with disseminated tuberculosis; delayed tuberculous intestinal perforation can develop during chemotherapy for tuberculosis.
authors: Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong. Electronic address: stl168@hotmail.com.
authors: Siu-Tong
authors: ST
authors: Law
authors: Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
authors: Sin-Chuen
authors: SC
authors: Chiu
authors: Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
authors: Kin Kong
authors: KK
authors: Li
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D018664:Interleukin-12 / Q000172:deficiency*; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D018664:Interleukin-12