Tuberculosis of gastrointestinal tract revealed by acute abdomen due to ileocecal perforation in an HIV-infected patient: A case report

Introduction: Gastrointestinal tuberculosis (TB) is a rare condition, but it poses significant diagnostic and management challenges, especially in immunocompromised individuals. This case report discusses the diagnostic complexities and therapeutic strategies for managing gastrointestinal TB in an HIV-positive patient, emphasizing the importance of considering TB in differential diagnoses.

Case presentation: A 33-year-old male with no significant medical history presented with a five-day history of severe abdominal pain, initially epigastric and later localized to the right lower quadrant (RLQ). Physical examination revealed RLQ tenderness, and elevated inflammatory markers were observed in laboratory tests. Imaging studies suggested splenomegaly and signs consistent with acute appendicitis. Laparotomy uncovered a perforated cecal mass and diffuse white lesions across the small intestine. Histopathological analysis confirmed necrotizing granulomatous colitis, and PCR identified Mycobacterium tuberculosis (MTB). During hospitalization, the patient was diagnosed with HIV.

Clinical discussion: This case underscores the diagnostic challenge of abdominal TB, particularly in HIV-infected patients where clinical presentation can mimic other conditions like Crohn's disease or appendicitis. Effective management requires timely surgical intervention, followed by appropriate anti-tuberculous and antiretroviral therapies. The multidisciplinary approach ensures comprehensive care and better patient outcomes.

Conclusion: Effective recognition and diagnosis of gastrointestinal TB in HIV-positive patients are critical for successful treatment. This report highlights the necessity for heightened clinical suspicion and a collaborative approach in managing such complex cases, ultimately improving patient prognosis and care.