There has been a resurgence of intestinal tuberculosis during the last decade following
the increase of immigrants to Western countries [1]
[2]. The abdominal symptoms of intestinal tuberculosis are nonspecific, consisting mainly
of abdominal pain, weight loss, anorexia, and fever [2]
[3]. The characteristic endoscopic features of colonic tuberculosis include transversely
oriented ulcer, nodules, deformed ileocecal valve, stricture, erosions, and aphthous
ulcers [1]
[2]
[3]. However, in patients without abdominal symptoms or pulmonary infection, endoscopists
face the challenge of distinguishing between intestinal tuberculosis and malignancy
or Crohn’s disease. We report here a case of colonic tuberculosis found incidentally
during a health check-up, and which was diagnosed by typical endoscopic features and
histological and microbiological evidence.
A 38-year-old, previously healthy man visited our institution for a scheduled health
check-up. His medical history and physical examination were unremarkable. He had a
history of travel to China 3 months before coming to our hospital. Chest radiograph
showed no active pulmonary lesions. Laboratory data were within reference range except
for a triglyceride level of 381 mg/dL (normal range 50 - 130 mg/dL). Tumor markers
including CEA, CA 125 and CA 19 - 9 were normal. Ziehl-Neelsen stain and culture of
sputum were negative for Mycobacterium tuberculosis.
Colonoscopy revealed a transversely oriented ulcer in the cecum, with steep edges
and surrounding flared nodules (Figure [1]). The terminal ileum appeared normal. Histological examination of the biopsy specimens
demonstrated well-formed granulomas with caseous necrosis and Langhan’s giant cells
(Figure [2]). Culture of biopsy specimens revealed positivity for M. tuberculosis, as did the result of polymerase chain reaction for DNA of M. tuberculosis. A diagnosis of colonic tuberculosis was made. The patient received antitubercular
therapy for 9 months with an uneventful clinical course. He remained asymptomatic
over the ensuing 2 years of follow-up.
Endoscopy_UCTN_Code_CCL_1AD_2AC
Figure 1 Colonoscopic view showing a transversely oriented ulcer in the cecum with steep edges
and flared surrounding nodules. Note its location opposite the ileocecal orifice (arrow).
Figure 2 Histological view showing well-formed granulomas with Langhan’s giant cells (arrows)
and caseous necrosis (n), surrounded by a prominent rim of lymphocytes (hematoxylin
and eosin; original magnification × 100).
