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Intestinal Tuberculosis as First Manifestation of Human Immunodeficiency Virus (HIV) Infection. A Single History Snapshot

Miguel F Carrascosa, José R Salcines-Caviedes, Juan M Corral-Mones, Javier Gómez-Román and Marta Cano-Hoz

A 33-year-old man was admitted in 1999 because of abdominal pain, fever, and weight loss. After a presumptive diagnosis of acute complicated appendicitis, laparotomy was carried out. Since cecum and terminal ileum showed a `carcinomatous appearance´ ileocecal resection and right hemicolectomy were performed. Pathological assessment revealed the presence of acid-fast bacilli which were later identified as Mycobacterium tuberculosis. There was no evidence of neoplasia. As the patient had been intravenous drug user and had absolute lymphopenia, Human Immunodeficiency Virus serology was requested after surgery, with the result being positive. The patient was placed on standard antituberculous therapy and was discharged. However, he decided to stop quickly the treatment and was readmitted 3 month after discharge because of fever and cervical lymphadenitis. Culture of a neck lymph node sample grew Mycobacterium tuberculosis. This time, the patient took appropriately antituberculous drugs and also initiated antiretroviral treatment. Except for some diarrheic episodes, he has remained well throughout the follow-up period (from June, 1999 to December, 2013). It is well known that there is no such thing as an easy diagnosis of intestinal tuberculosis, even nowadays. We have just tried to remember it.