We report the case of a 33-year-old South American male, resident in Spain since 4, who was admitted for constitutional syndrome, fever, cough and abdominal pain of 7 months duration.
The patient had a history of hospitalization two years earlier due to parapneumonic effusion and tonsillitis treated with albendazole.
The examination revealed fever (38.2 oC), normotensive and eupneic, with a painful abdomen diffusely tenderness without peritonitis and intestinal sounds present.
Laboratory tests showed anemia (hemoglobin 7.7 g/dl), leukocytes 7,300 (88% segmented; 9.1% lymphocytes; 2.2% monocytes), 631,000 platelets, ESR: 127 mm/h and total proteins 51 g).
She was diagnosed with smear-positive pulmonary tuberculosis and positive cultures for Mycobacterium tuberculosis.
Chest X-ray was normal and computed tomography (CT) showed numerous multifocal pulmonary parenchymal nodules, thickening of the intestinal wall, peritoneal and mesentery implants, as well as multiple adenopathy.
Colon-ileoscopy identified in the terminal ileum a mucosa with edematous appearance, nodular, in pedaling, friable and ulcerations corresponding to tuberculous ileitis.
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Antituberculosis treatment was initiated with isoniazid, rifampicin and pyrazinamide, but after two weeks of torpid evolution, the patient presented clinical signs compatible with acute surgical abdomen.
On CT, pneumoperitoneum and fluids were observed, so the patient was urgently intervened.
Numerous white implants of primary refrigeration type were found in the peritoneal cavity, serosa intestinalis and omentum. A perforation of the terminal ileum was also found after treatment with suture.
During the following 2 months the patient had to be operated on two occasions due to new episodes of perforation in the jejunum and ileum, identifying the perforation and practicing suture in both cases.
In the last intervention, adequate healing of the perforations sutured previously was confirmed.
The anatomopathological result of the obtained samples revealed the presence of chronic granulomatous inflammation caseifying type TB and absence of acid-resistant bacilli (BAAR) with Ziehl-Nielsen staining.
Ascitic fluid culture was also negative for AFB.
