Vnitr Lek 2017, 63(5):354-360 | DOI: 10.36290/vnl.2017.071

Is it intestinal tuberculosis again? Case report

Kristián Brat^1,*, Zdeněk Merta¹, Ivan Čundrle²

¹ Department of Respiratory Diseases, Faculty of Medicine, Masaryk University and University Hospital Brno

² Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno

This case report focuses on an immigrant admitted to the Department of Respiratory Diseases, University Hospital Brno due to suspicion of relapsing intestinal tuberculosis. The patient presented with fever, night sweat, weight loss, diarrhea, and a history of several tuberculosis attacks in the last few years. None of the examinations confirmed the presence of active tuberculosis but raised suspicion of hematological malignancy. Pancytopenia was present in the peripheral blood. However, bone marrow examination and flowcytometry excluded the presence of a hematological malignancy. The results pointed to the possibility of vitamin B₁₂ or folate deficiency that were both confirmed consequently by serum biochemical tests. Cobalamin and folate deficiency were caused by short bowel syndrome that developed after a major intestinal resection that the patient underwent in his past. Combined treatment including vitamins, pancreatic enzymes substitution, antidiarrhoics and spasmolytics was administered. The general health status of the patient improved rapidly with restitution of hematopoiesis, weight gain, and a decrease by 80% in daily number of stools. Clinical appearance of intestinal tuberculosis, short bowel syndrome and of cobalamin and folate deficiency as well as pathophysiology, diagnosis and treatment of these uncommon or even rare diseases are discussed in this case report.

Keywords: intestinal tuberculosis; pancytopenia; short bowel syndrome; vitamin B₁₂ deficiency

Received: March 16, 2017; Accepted: May 25, 2017; Published: May 1, 2017  Show citation