Tuberculosis intestinal: un diagnóstico para no olvidar. Reporte de un caso
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Resumen
La tuberculosis continúa siendo una causa importante de morbimortalidad en Colombia y el mundo, con un aumento en las formas extra pulmonares, de las cuales el compromiso intestinal ocupa el sexto lugar. Sus manifestaciones clínicas son inespecíficas y pueden simular múltiples condiciones, lo que hace de su diagnóstico un reto clínico. Este artículo describe el caso de una paciente con tuberculosis intestinal, a quien no se documentó un hallazgo confirmatorio, pero por la sospecha clínica y hallazgos paraclínicos sugestivos, se decide iniciar tratamiento antituberculoso, con respuesta clínica favorable luego de dos semanas.
Citas
Organización Mundial de la Salud. Global tuberculosis report 2012.
Medellín ciudad saludable. Boletín epidemiológico. Boletín número 2: 2013 Disponible en : http:// medellin.gov.co/salud
Ministerio de salud. Guía de atención de la tuberculosis pulmonar y extra pulmonar [Internet]. Disponible en: http://www.col.ops-oms.org/prevencion/tuberculsis/guia_tuberculosis.pdf
Donoghue, H. D., Holton, J. Intestinal tuberculosis. Curr Opin Infect Dis 2009; 22(5):490–496.
Giouleme O, Paschos P, Katsaros M, Papalexi F, Karabatsou S, Masmanidou M. et al. Intestinal tuberculosis: a diagnostic challenge-case report and review of the literature. Eur J Gastroenterol Hepatol 2011; 23(11):1074–1077.
Loh KWJ, Bassily R, Torresi J. Crohn’s disease or tuberculosis? J Travel Med 2011; 18(3):221–223.
Rolo R, Campainha S, Duarte R. Crohn’s disease and intestinal tuberculosis: A clinical challenge. Rev Port Pneumol 2012; 18(4):205–206.
Manuel LZ, Wiggins J. Gastrointestinal tuberculosis: a diagnosis not to miss. J R Coll Physicians Edinb 2010; 40(3):209–212.
Leung VKS, Law ST, Lam CW, Luk ISC, Chau TN, Loke TKL, et al. Intestinal tuberculosis in a regional hospital in Hong Kong: A 10-year experience. Hong Kong Med J 2006; 12(4):264–271.
Ihama Y, Hokama A, Hibiya K, Kishimoto K, Nakamoto M, Hirata T, et al. Diagnosis of intestinal tuberculosis using a monoclonal antibody to Mycobacterium Tuberculosis. World J Gastroenterol 2012; 18(47):6974–6980.
Flor D, Ramírez DM, Bustamante RC, Manuel E, Monjaráz T, Ericka D, et al. Tuberculosis intestinal primaria: reporte de caso y revisión de la literatura Etiología y transmisión. Rev Enferm Infec Pediatr 2010; 24(94):73–79.
Gómez-Zuleta MA, Viveros-Carreño D, Cañón P. Tuberculosis intestinal: reporte de caso y revisión de la literatura. Infect 2012; 16(3):178–182.
Benito P, Prieto V, Geijo F, Fradejas P, Sánchez A, Velasco A. et al. Tuberculosis intestinal: un reto diagnóstico. Rev Esp Enferm Dig 2008; 100(2):109-110.
Almadi MA, Ghosh S, Aljebreen AM. Differentiating intestinal tuberculosis from Crohn’s disease: A diagnostic challenge. Am J Gastroenterol 2009; 104(4):1003–1012.
Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M, et al. Clinical, endoscopic, and histological differentiations between Crohn’s disease and intestinal tuberculosis. American J Gastroenterol 2010; 105(3):642–651.
Pulimood AB, Amarapurkar DN, Ghoshal U, Phillip M, Pai CG, Reddy DN, et al. Differentiation of Crohn’s disease from intestinal tuberculosis in India in 2010. World J Gastroenterol 2011; 17(4):433–443.
Ortega R, Angel LA, Gutiérrez O, Calvo E. Tuberculosis intestinal Una enfermedad que se rehúsa a desaparecer. Acta Med Colom 1994; 19(5):285–291.
Sato S, Yao K, Yao T, Schlemper RJ, Matsui T, Sakurai T, et al. Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients. Gastrointest Endosc 2004; 59(3):362–368.
Misra SP, Misra V, Dwivedi M. Ileoscopy in patients with ileocolonic tuberculosis. World J Gastroenterol 2007; 13(11):1723–1727.
Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008; 14(5):741–746.
Pulimood AB, Peter S, Ramakrishna BS, Chacko A, Jeyamani R, Jeyaseelan L, et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn’s disease. J Gastroenterol Hepatol 2005; 688–696.
Pulimood AB, Peter S, Rook GW. Donoghue HD. In situ PCR for Mycobacterium tuberculosis in endoscopic mucosal biopsy specimens of intestinal tuberculosis and Crohn disease. Am J Clin Pathol 2008; 129(6):846–851.
Jin XJ. Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn’s disease. World J Gastroenterol 2010; 16(20):2496.
Shaikh MS, Dholia KRAM, Jalbani MA, Shaikh SALI. Prevalence of intestinal tuberculosis in cases of acute abdomen. Pakistan Journal of Surgery 2007; 23(1):52-56.
Ye BD, Yang S, Kim D, Shim TS, Kim S, Kim M, et al. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis 2012; 799–804.
Kim BJ, Choi YS, Jang BI, Park YS, Kim WH, Kim YS, et al. Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn’s disease. Inflammatory bowel diseases. Inflamm Bowel Dis 2011; 17(6):1308–1313.
Rao YG, Pande GK, Sahni P, Tushar K. Gastroduodenal tuberculosis management guidelines , based on a large experience. Can J Surg 2004; 47(5):364–368.
Kim SG, Kim JS, Jung HC, Song IS. Is a 9-month treatment sufficient in tuberculous enterocolitis ? A prospective, randomized, single-centre study. Aliment Pharmacol Ther 2003; 18(1):85–91.
Lee MJ, Cresswell FV, John L, Davidson RN. Diagnosis and treatment strategies of tuberculous intestinal perforations: a case series. Eur J Gastroenterol Hepatol 2012; 24(5):594–599.