AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report

Hyun Keun Kim; Soon Uk Choi; Ju Young Ahn; Sang Jun Park; Youn Kwon Kim; Soyon Kim; Jae Hyun Cho

doi:10.3947/ic.2009.41.6.366

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Kim, Choi, Ahn, Park, Kim, Kim, and Cho: AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2009; 41(6): 366-370.

Published online: 31 December 2009

DOI: https://doi.org/10.3947/ic.2009.41.6.366

AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report

Hyun Keun Kim, M.D., Soon Uk Choi, M.D., Ju Young Ahn, M.D., Sang Jun Park, M.D., Youn Kwon Kim, M.D., Soyon Kim, M.D., Jae Hyun Cho, M.D.

Department of Internal Medicine, National Police Hospital, Seoul, Korea.

Corresponding author: Jae Hyun Cho, M.D. Department of Internal Medicine, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul 138-708, Korea. Tel: +82-2-3400-1516, Fax: +82-2-3400-1111, jaehyun@chojh.net

Received 24 June 2009 Accepted 7 October 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Extrapulmonary tuberculosis, such as intestinal tuberculosis, has become more common with the increase in human immunodeficiency virus infection. However, the diagnosis and treatment of intestinal tuberculosis are often delayed because the symptoms are nonspecific and diverse. We experienced a case of AIDS with intestinal tuberculosis that manifested as a duodenal fistula. The presence of AIDS should be suspected in patients who have extrapulmonary tuberculosis with atypical presentations.

Keywords: Acquired immunodeficiency syndrome, Tuberculosis, Gastrointestinal, Intestinal fistula

Figures and Tables

Figure 1

Small bowel series. Small bowel series show leakage of contrast media between the 2nd and 3rd portion of the duodenum.

Figure 2

Gastroduodenoscopy. Gastroduodenoscopy shows an ulcer with broad base which has an irregular and dirty margin on the 2nd portion of duodenum.

Figure 3

Histologic findings of duodenal ulcer. A) Few granulomas composed of epithelioid histiocytes with/without tiny central necrosis are shown in submucosa and lamina propria (H&E stain, ×100). B) Acid-fast bacilli are found with acid fast staining (Ziehl-Neelsen stain, ×400).

Figure 4

Abdominopelvic computed tomography. Abdominopelvic computed tomography shows many rim-enhancing nodules along hepatoduodenal ligament, portocaval space, celiac axis, retrocaval space, aortocaval space, mesenteric root, and mesentery.

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