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Introduction: Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare entity that mimics various inflammatory strictures of the small intestine. Pediatric literature is scarce. We analyzed the clinical, radiological, endoscopic and histopathological features of children with CMUSE that differentiate it from small bowel Crohn's disease (SBCD) and gastrointestinal tuberculosis (GITB)., Methods: CMUSE was diagnosed by the following criteria: (1) unexplained small bowel strictures with superficial ulcers, (2) chronic/relapsing ulcers of small bowel after resection, (3) no signs of systemic inflammation, (4) absence of other known etiologies of small bowel ulcers. SBCD and GITB were diagnosed based on standard criteria. The clinical features, laboratory parameters, radioimaging, endoscopy (including video capsule endoscopy [VCE], intra-operative endoscopy), histopathological features and treatment outcome were noted., Results: Out of 48, CMUSE was diagnosed in 13 (27%) isolated small bowel and ileocecal strictures, while GITB and SBCD accounted for 41% and 21% cases, respectively. Common presentations were sub-acute obstruction (46%), obscure gastrointestinal bleeding (38%) and protein-losing enteropathy (38%). CMUSE patients had significantly longer disease duration compared to SBCD and GITB (p < 0.001). SBCD (90.0%) and GITB (85%) cases had elevated C-reactive protein (CRP), none with CMUSE had elevated CRP (p < 0.001). The disease was localized in jejunum (100%) and proximal ileum (56%) in CMUSE, ileocecal region (85%) in GITB, but evenly distributed in small intestine in SBCD. Endoscopy showed evenly placed, superficial, circumferential ulcers with strictures in CMUSE, deep linear ulcers in SBCD and circumferential ulcers in GITB. Upfront immunosuppression was given in four; three (75%) of them relapsed. Only surgery was done in three with one (25%) having relapse. Upfront surgery followed by immunosuppression was used in six, but all relapsed and two required repeat surgery., Conclusion: CMUSE is important but underdiagnosed in children. Lack of constitutional symptoms, normal inflammatory parameters and characteristic ulcers with strictures helped in differentiating CMUSE from GITB and SBCD., (© 2024. Indian Society of Gastroenterology.)

In Southeast Asia, the higher prevalence of Intestinal tuberculosis (TB) challenges the diagnosis of Crohn's disease (CD) due to their overlapping symptoms. This case involves a 25-year-old male misdiagnosed with Intestinal tuberculosis presenting with abdominal pain, weight loss, and bowel ulceration. Recurrence after anti-tubercular therapy led to further investigation paving to right hemicolectomy and histopathological analysis confirming Crohn's disease. This case highlights the complexity of the diagnosis of Crohn's disease in tuberculosis-prevalent areas, stressing the clinical importance, advanced diagnostics tools, and multidisciplinary approach for effective intervention.

Extrapulmonary tuberculosis (TB) in the gastrointestinal tract is a rare, but yet an essential differential diagnosis to patients with complex fistula disease, since the initiation of immunosuppressive therapy for presumed Crohn's disease can lead to a fulminant course of TB. This case report presents a young Danish woman with a progressive complex fistula disease, where cause and treatment were uncovered by interprofessional collaboration between pulmonologists, gastroenterologists and surgeons including a screening test for TB as well as multiple biopsies from the anal fistula tissue., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Tuberculosis (TB), caused by Mycobacterium tuberculosis , is a leading infectious disease with varied manifestations. We report a rare presentation of gastric TB in a 50-year-old immunocompetent woman from the Middle East with no prior medical history. The patient presented with persistent epigastric pain, weight loss, nausea, and vomiting over a 2-month duration. Imaging studies and an infectious disease panel were inconclusive. However, upper endoscopy revealed a subepithelial lesion at the pylorus, with biopsies demonstrating caseating granuloma and multinucleated giant cells. A QuantiFERON test was subsequently positive for TB. The patient was successfully treated with standard TB quadruple therapy, resulting in significant improvement in symptoms during follow-up. This case underscores the importance of considering extrapulmonary TB in immunocompetent patients with atypical gastrointestinal symptoms and highlights the efficacy of prompt antitubercular therapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A woman in her 20s with a recent diagnosis of Crohn's disease (CD) affecting the ileocaecal valve was started on adalimumab, after routine tuberculosis (TB) tests were negative. Her abdominal symptoms got worse and she started presenting respiratory distress and fever. Tomography revealed a left pleural effusion, pneumonia and peritonitis with pelvic abscess. The diagnosis of disseminated TB with digestive involvement was suggested and sputum cultures were positive for Mycobacterium tuberculosis Treatment for TB was started and immunosuppressants discontinued, leading to respiratory improvement. Abdominal imaging was repeated, showing worsening signs of multisegmental ileal wall thickening, ileocaecal valve obstruction and a persistent pelvic abscess. She was then submitted to a laparoscopic ileocaecal resection for suspicion of worsening CD. Histopathology showed chronic ileocolitis compatible with CD and ganglionic tuberculosis, revealing the diagnosis of intestinal tuberculosis superimposed in CD. Recovery was uneventful., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

MSP is a rare and atypical form of benign granulomatous inflammation characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria, which should be differentiated from neoplastic lesions. A 26-year-old Chinese man complained an intermittent and mild right lower abdominal pain for 5 months in May 2022.Histopathology of biopsy samples showed Mycobacterial spindle cell pseudotumor (MSP). The test of Mycobacterium tuberculosis detected by polymerase chain reaction using intestinal tissue slice was negative. The metagenomic next-generation sequencing (BGI-Shenzhen) using formalin-fixation and paraffin-embedded intestine samples confirmed Mycobacterium tuberculosis complex (MTBC).

Rationale: Limited literatures are available on lower gastrointestinal bleeding in systemic lupus erythematosus (SLE) combined with intestinal tuberculosis. Sharing the treatment experiences of a 26-year-old female patient diagnosed with this complex condition in this report may contribute valuable insights., Patient Concerns: The patient initially presented with abdominal pain and active gastrointestinal bleeding, leading to admission to the hospital. Over a 2-week period, she experienced persistent bleeding, with daily volumes ranging from 300 mL to 800 mL., Diagnoses: Lower gastrointestinal bleeding was diagnosed in this patient with concurrent systemic lupus erythematosus and intestinal tuberculosis., Interventions: As her symptoms rapidly progressed, food and water intake had to be completely restricted. The parenteral nutrition was implemented., Outcomes: The medical team effectively controlled the bleeding, leading to a notable improvement in the patient's condition. Consequently, she was able to resume oral intake and was discharged from the hospital., Lessons: This case highlights the significance of using parenteral nutrition in the management of lower gastrointestinal bleeding in patients with concurrent systemic lupus erythematosus and intestinal tuberculosis. Close monitoring and collaborative efforts among healthcare professionals are crucial to achieve successful outcomes in similar cases., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Abdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population., Methods: This was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study., Results: A total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up., Conclusion: Abdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Intestinal tuberculosis is a chronic and specific infection caused by Mycobacterium tuberculosis invading the intestine. Due to the nonspecific clinical presentation, it is stressed that intestinal perforation complicates umbilical intestinal fistula and bladder ileal fistula is very rare and extremely difficult to be diagnosed. It is significant to identify the disease and take urgent intervene in the early stage., Case Presentation: An 18-month-old boy patient presented with abdominal pain. Abdominal CT suggested abscess formation in the right lower abdomen and pelvis. The patient underwent resection of necrotic and stenotic intestinal segments with the creation of an ileostomy, cystostomy and vesicoureteral fistula repair for the presence of intestinal perforation complicated by vesicoureteral fistula and umbilical enterocutaneous fistula. Histopathology confirmed the intestinal tuberculosis. The patient was discharged successfully after 11 days post anti-tuberculosis treatment., Conclusion: Our case report here is a rare case of umbilical intestinal fistula with bladder ileal fistula secondary to intestinal perforation from intestinal tuberculosis. The purpose of this report is to make the surgical community aware of atypical presentations of intestinal tuberculosis. If our peers encounter the similar situation, they can be prepared for corresponding diagnosis and treatment., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Competing Interests: None

Abdominal tuberculosis is defined as infection of gastrointestinal tract, peritoneum, abdominal solid organs, and/or abdominal lymphatics constituting approximately 12% of extra-pulmonary tuberculosis cases. Intestinal perforation is an acute presentation of abdominal tuberculosis. Intestinal perforation can occur before or at the beginning of anti-tubercular therapy. It is considered to be a paradoxical reaction if it occurs during or after treatment. Intestinal perforation is uncommon but serious and life-threatening as complication-mortality rate secondary to perforation are estimated to be >30%. We present a case of an 18-year-old female who developed cecal perforation following an intraperitoneal abscess after completion of anti-tubercular therapy for intestinal tuberculosis. She was a known case of intestinal tuberculosis. She had undergone pigtail catheterisation for an intraperitoneal abscess and completed 18 months of anti-tubercular therapy after which she developed cecal perforation. A paradoxical response was observed following the completion of anti-tubercular therapy. Early diagnosis and treatment reduce the complications and mortality rates of cecal perforation due to abdominal tuberculosis., Keywords: case reports; cecum; intestinal perforation; tuberculosis.

We report a case of isolated duodenal tuberculosis (TB) in a patient who presented with features of gastric outlet obstruction. The diagnosis was made on repeat endoscopic duodenal biopsy after initial histopathology failed to reveal the diagnosis. The patient recovered with antitubercular therapy. The index of suspicion has to be high in TB endemic countries as clinical, radiological, and endoscopic features are nonspecific., (© Journal of the Association of Physicians of India 2011.)

Rationale: Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another., Patient Concerns: A 59-year-old man visited our clinic with dizziness and anorexia., Diagnosis: Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas., Interventions: Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed., Outcomes: The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells., Lessons: In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

While gastrointestinal (GI) tuberculosis (TB) accounts for 1%-3% of all TB cases worldwide, TB of the stomach is extremely rare and accounts for 1%-2% of all GI TB. Little is known about this entity, and most data are obtained from case reports. We report a case of a woman in her 60s who presented with a 2-week history of generalised weakness, fatigue and shivering, with severe loss of appetite on background history of dyspepsia and significant weight loss for the preceding 2 years. Upper endoscopy revealed a large gastric ulcer. Biopsy and histopathology revealed caseating granulomas with numerous acid-fast bacilli detected with Ziehl-Neelsen stain. She was diagnosed with gastric TB. Subsequently, she was also diagnosed with pulmonary, adrenal and colonic involvement., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Patients can present for a wide variety of etiologies for dysphagia, and it is important to consider less common causes once common etiologies have been ruled out. Extrapulmonary Mycobacterium tuberculosis (TB) presentations are rare to see in the western populations due to relative lack of TB exposure and overall less immunocompromised populations, but should be considered for at-risk patients. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB (EPTB)., Case Presentation: This is a case report of a 35-year-old Ethiopian male presenting with dysphagia and retrosternal odynophagia who was found to have infiltration of mediastinal lymphadenopathy into the esophageal wall secondary to TB. This patient underwent an upper endoscopy, which revealed a linear 2 cm full thickness mucosal defect in the middle esophagus concerning for an infiltrative process with full thickness tear. Computed tomography (CT) of the chest demonstrated a subcarinal soft tissue mass that was inseparable from the esophagus. He was referred to thoracic surgery and underwent an exploratory mediastinal dissection. A mediastinoscopy scope was inserted and the mediastinal dissection was made until the subcarinal nodes were identified and removed. Biopsy results showed necrotizing and non-necrotizing granulomas, and acid-fast bacilli (AFB) culture from the surgically removed lymph node showed Mycobacterium TB complex growth. He had no known TB exposures and did not have any TB risk factors. He then followed up in infectious disease clinic and was managed with anti-tuberculosis treatment (ATT) with complete resolution of symptoms., Conclusions: Our patient was ultimately found to have esophageal TB secondary to mediastinal invasion into the esophageal wall from lymphadenopathy associated with TB. This is an extremely rare presentation in western populations due to diminished exposure rates and overall less immunocompromised populations compared to impoverished countries with increased TB exposure and human immunodeficiency virus (HIV) infection rates. Although TB is not as commonly seen in western populations, it should be considered on the differential for any atypical presentations of GI diseases for patients with clinical or geographic risk factors., (© 2022. The Author(s).)

Introduction: Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce., Methods: A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients., Results: Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn's disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1-5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons., Conclusion: Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract., (© 2022. The Author(s).)

Differential diagnosis of a new abdominal mass is broad and includes infection, malignancy and other inflammatory processes. Definitive diagnosis may be challenging without invasive biopsy, as history, physical exam and imaging may be non-specific. A 69-year-old man with a history of abdominal tuberculosis presented with a new painful abdominal cyst consistent with reactivation of tuberculosis versus new malignancy. Investigations revealed 4+ acid-fast bacilli from the aspirate suggestive of tuberculosis, but no improvement was noted on antituberculous therapy. Core needle biopsy noted c-KIT-positive spindle cells, diagnostic for a gastrointestinal stromal tumour, while cultures grew non-tuberculous mycobacteria., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To determine the features of diagnosis and clinical course of abdominal tuberculosis in children., Material and Methods: Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens., Results: Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed., Conclusion: Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

Mucormycosis represents several unusual opportunistic infection caused by saprophytic aseptate fungi. There is a recent rise in cases of mucormycosis due to an increase in diabetic and immunodeficient patients like patients on long-term steroids, immunomodulators due to organ transplantation, malignancies, mainly haematological malignancies, and autoimmunity. Anatomically, mucormycosis can be localised most commonly as rhino-orbito-cerebral followed by pulmonary, disseminated, cutaneous and gastrointestinal, rarest being small intestinal. Patients with Down syndrome are immunodeficient due to their impaired immune response. Disseminated tuberculosis is also common in immunodeficient patients. We report a rare case of small intestinal mucormycosis in a patient with Down syndrome with coexisting intestinal tuberculosis. Due to the invasiveness of mucormycosis, the patient succumbed to death despite providing aggressive surgical debridement and medical management., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract: Abdominal tuberculosis (TB) is rare in children and usually spread in the peritoneum or gastrointestinal tract. Symptoms tend to be vague and nonspecific, with no extra-abdominal involvement, presenting a challenge for clinicians and delayed diagnosis. Postnatally acquired abdominal TB is most commonly transmitted through inhalation or ingestion of respiratory droplets with Mycobacterium tuberculosis from the mother.Abdominal TB in infants is rare. We present a case of a 2-month-old infant presenting with an acute bowel obstruction secondary to abdominal TB acquired through contact with maternal TB mastitis. This unique case emphasizes the importance of considering abdominal TB in the differential for at-risk infants presenting with small bowel obstruction., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Diagnosis of intestinal tuberculosis poses a dilemma to physicians due to nonspecific symptoms like abdominal pain, fever, nausea, and a change in bowel habit. In particular, the distinction between inflammatory bowel disease and intestinal tuberculosis remains challenging., Case Presentation: A 27-year-old man from Colombia presented with fever, night sweats, and progressive lower abdominal pain. Computed tomography revealed a thickening of the bowel wall with a mesenterial lymphadenopathy, ascites ,and a pleural tumor mass. Histology of intestinal and pleural biopsy specimens showed a granulomatous inflammation. Although microscopy and polymerase chain reaction (PCR) for Mycobacterium tuberculosis (MTB) were negative, empirical MTB treatment was initiated on suspicion. Due to a massive post-stenotic atrophied intestinal bowel, MTB medications were administered parenterally in the initial phase of treatment to guarantee adequate systemic resorption. The complicated and critical further course included an intra-abdominal abscess and bowel perforation requiring a split stoma, before the patient could be discharged in good condition after 3 months of in-hospital care., Conclusions: This case highlights the clinical complexity and diagnostic challenges of intestinal MTB infection. A multidisciplinary team of physicians should be sensitized to a timely diagnosis of this disease, which often mimics inflammation similar to inflammatory bowel disease, other infections, or malignancies. In our case, radiological findings, histological results, and migratory background underpinned the suspected diagnosis and allowed early initiation of tuberculostatic treatment.

Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Gastroduodenal tuberculosis is an uncommon form of abdominal tuberculosis., Areas Covered: We report our experience with five cases of gastroduodenal tuberculosis and present results of a systematic review on gastroduodenal tuberculosis regarding clinical presentation, endoscopic, imaging findings, and the diagnostic and therapeutic approach., Expert Opinion: The presentation of gastroduodenal tuberculosis is diverse and may include nonspecific abdominal pain or dyspepsia like symptoms apart from gastric outlet obstruction. Endoscopy may show presence of growth, ulcer, narrowing, or fistula on endoscopy. Endoscopic biopsy, well-biopsy, or mucosal resection of an elevated lesion are helpful. On microscopy, granuloma with or without acid fast bacilli positivity can be found. For treatment, standard antitubercular therapy should be given for 6 months. In patients with tight stricture, endoscopic balloon dilatation can be helpful. Surgery is reserved for patient with diagnostic dilemma, refractory stricture, or complications like perforation or fistula. Future research should focus on improving diagnosis with use of modern microbiological techniques like PCR and Xpert MTB/RIF.

Background: Tuberculosis (TB) is a major health problem worldwide. Even in highly prevalent countries, primary gastroduodenal tuberculosis is a rare manifestation of extrapulmonary tuberculosis. In recent years, as the incidence of tuberculosis has increased year by year, the occur of gastroduodenal tuberculosis has also increased. Endoscopy is an important tool for diagnosing gastroduodenal tuberculosis. The performance of gastroduodenal tuberculosis under endoscopy is often non-specific, which may imitate other benign or malignant gastroduodenal diseases. Diagnosis of gastroduodenal tuberculosis relies on a combination of endoscopy and guided biopsy., Case Presentation: Here, we report a rare and interesting case of gastroduodenal tuberculosis with acute pancreatitis. The case initially mimicked gastroduodenal ulcers in morphology and appeared in a middle-aged person with normal immunity but with prolonged fever and abdominal pain. The disease was diagnosed through endoscopy and guided biopsy, and it responded well to antituberculosis drugs., Conclusions: Clinicians must remember that even in the absence of immunodeficiency, as in this case, tuberculosis can affect any part of the gastrointestinal tract.

Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she received empirical anti- tuberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

A 22-year-old young woman presented with fever, lower abdominal pain and vomiting for 20 days. She had persistent fever and abdominal pain. Fever panel was negative. Clinical features were suggestive of subacute small bowel obstruction. Contrast-enhanced CT abdomen showed thickening of distal ileum, ileocaecal junction and caecum with conglomerate necrotic nodal mass in the ileocolic mesentry along with a lesion in the tail of pancreas. Patient was discussed with multidisciplinary team and decided to undergo a single-stage procedure after adequate nutritional optimisation. During optimisation, she underwent acute obstruction and hence taken up for emergency laparotomy proceeded to right haemicolectomy with distal pancreatectomy and splenectomy 4 weeks after the time of admission. Histopathology showed ileocaecal tuberculosis and solid pseudopapillary tumour with margins free of tumour. Approach of obstructed ileocaecal tuberculosis in the setting of incidental diagnosis of solid pseudopapillary tumour of pancreas in a moribund patient was challenging., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Hodgkin lymphoma (HL) is a disease characterized by a high curability rate, and the treatment benefit-risk balance must be carefully addressed to achieve complete disease control with low risk of long-term toxicities. Most patients are treated with a combination of chemotherapy and radiotherapy, after disease staging and response to treatment evaluated by FDG PET/CT. We report the case of a 28-year-old patient concomitantly diagnosed of a Hodgkin lymphoma and active tuberculosis. Initial staging was difficult due to pulmonary and abdominal tuberculosis localization that induced FDG PET/CT hypermetabolism. Anti-tuberculosis treatment was first started, allowing secondary an early accurate Hodgkin lymphoma staging by FDG PET/CT. The patient was then treated by chemotherapy and radiotherapy. Helical TomoTherapy® was used with involved site (IS) irradiation volume was performed to decrease the high doses to organs-at-risk (OAR), especially lungs in this context of tuberculosis., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Esophageal tuberculosis is one of the rarest forms of tuberculosis with higher incidence in immunocompromised cases. In majority of cases it is seen associated with esophagomediastinal and esophagotracheal fistulas. Diagnosis is established with the help of esophagoscopy followed by histopathology and microbiological analysis of biopsy sample. Treatment with antituberculous therapy alone is sufficient in majority of cases, however surgical management is mandatory in severe and non resolving cases. We thereby report an interesting case of esophagomediastinal fistula presenting as drug resistant tuberculosis with retroviral disease., (Copyright © 2019 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Gastrointestinal tuberculosis is a rare extrapulmonary manifestation, it represents 3% of cases and mainly involves the ileocecal region; appendiceal involvement is rare. Tuberculous appendicitis can present as an acute condition indistinguishable from other causes of appendicitis and the diagnosis is generally made by histopathological finding, which delays treatment and can lead to complications. The postpartum period is at risk of a reactivation of tuberculosis, due to changes in the immune system that manifests as an immune reconstitution syndrome. We present the case of a postpartum patient admitted for septic shock secondary to perforated appendicitis, the pathology reported chronic granulomatous inflammation and subsequent confirmation by molecular technique of pulmonary tuberculosis.

Gastrointestinal tuberculosis manifesting as isolated duodenal involvement is uncommon. We present a case of 52 years old man with post-prandial abdominal pain, early satiety and weight loss. Upper endoscopy showed circumferential duodenal stricture adjacent to the ampulla with nodularity, erythema, and ulcerations of the overlying mucosa causing gastric outlet obstruction. Biopsy of duodenal stricture revealed chronic duodenitis and the patient was treated with acid suppression therapy. Endoscopic balloon dilation was also performed with no response. Abdominal computer tomography scan showed multiple enlarged abdominal lymph nodes and subsequent duodenal tissue culture was positive for Mycobacterium tuberculosis. His symptoms and duodenal stricture resolved completely after treatment with anti-tuberculous regimen.

We report a rare presentation of vulvar lymphangiectasia that developed secondary to gastrointestinal tuberculosis in a teenager, and its spontaneous resolution after anti-tuberculous treatment was completed., (© 2019 Wiley Periodicals, Inc.)

Poncet disease is a rare, acute-onset polyarthritis associated with active extra-articular tuberculosis (TB) without evidence of active infection in the affected joint and resolves without residual joint damage or long-term complications. Most cases are reported at the commencement of anti-tuberculous therapy (ATT). A 13-year-old girl with Poncet disease is reported which, despite almost 6 months of treatment for abdominal TB, manifested with bilateral knee joint involvement which resolved only with continuation of ATT. A synovial biopsy was sterile.

Tuberculosis is a major health problem in India. Gastrointestinal tuberculosis is the sixth most common causes of extrapulmonary tuberculosis and it mostly involves the ileocaecal region. Primary gastric tuberculosis in immunocompetent person is very rare. Stomach as its site is rare and is the sixth most common site of gastrointestinal tuberculosis. It mostly presents as a cases of non healing ulcer or gastric outlet obstruction. Yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions and mostly they are diagnosed after surgical intervention. We report a case of isolated gastric tuberculosis in a middle age immunocompetent female who present as a cases of non healing ulcer and responded well to standard antitubercular treatment. A high index of its suspicion should be kept in mind in any chronic infiltrative lesions of stomach like non healing ulcers and gastric outlet obstruction for its early diagnosis and treatment., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Mycobacterium tuberculosis is highly endemic in the Philippines. The diagnosis is challenging with its non-specific presentation and the organism could extend to any of the organs. Interestingly, bacterial peritonitis arising spontaneously from gastrointestinal tuberculosis (TB) in an otherwise healthy, non-cirrhotic patient is quite unusual. In this paper, we discuss the case of a 27-year-old HIV-seronegative woman with massive intraperitoneal mixed bacterial and tuberculous abscess presenting 20 months after being diagnosed with bacteriologically confirmed gastrointestinal TB. Repeated large-volume paracentesis was done to drain out the infected ascites instead of inserting a percutaneously implanted catheter. Clinical improvement was noted and she was discharged after 12 days of intravenous antibiotics. She had completed 6 months of antituberculosis therapy and been well since then. The case has demonstrated that repeated paracentesis along with appropriate antibiotic regimen, may be a viable option for patients with TB and bacterial coinfected peritonitis. And possibly, peritoneal TB may increase the risk for (spontaneous) bacterial peritonitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Tuberculosis (TB) of the esophagus is an extremely rare condition, even in immunocompromised patients. We report the case of a 24-year-old man with a past history of HIV and pulmonary tuberculosis who presented with dysphagia and a 2cm submucosal mass in the proximal esophagus. The biopsy was diagnosed as a spindle cell neoplasm in another center. Sections displayed a submucosal lesion formed by spindle and epithelioid cells, surrounded by chronic inflammation. The spindle cells were positive for S100 and CD68, but negative for cytokeratin, desmin, smooth muscle actin, ALK, CD34 and CD117. Ziehl-Neelsen stain was performed and showed many intracellular acid-fast bacilli, confirming the diagnosis of esophageal TB. This case is a reminder that esophageal TB may become manifest as a submucosal lesion and the histiocytic-granulomatous reaction may mimic a spindle cell tumor., (Copyright © 2019 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)