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Reactivation Intra-abdominal Tuberculosis

A 22-year-old man was born in Bangladesh, had a history of treated pulmonary tuberculosis at 11 years of age, and has lived in the United States for eight years with no symptoms. He presented with pain and tenderness of the right iliac fossa. A computer tomogram of the abdomen demonstrated an edematous appendix and abdominal lymphadenopathy. The patient underwent a laparoscopic appendectomy, removal of a mesenteric lymph node, and liver biopsy. Multiple liver plaques (arrow head) and enlarged mesenteric lymph nodes were seen (Figure 1A, arrow). Histopathology showed liver granulomata with multinucleated giant cells (Figure 1B). Caseating granulomata largely replaced the lymphoid architecture of the excised lymph node but was acid fast bacilli (AFB) stain-negative (Figure 1C). Mycobacterium tuberculosis grew from culture of the lymph node. The appendix showed neutrophils in its wall and no granuloma. The patient received anti-tuberculosis therapy and recovered.

View larger version (113K): [in this window] [in a new window]       FIGURE 1. The gross and microscopic demonstration of the granuloma in the liver and mesenteric lymph nodes. A, Laparoscopic view of the liver plaques and enlarged mesenteric lymph nodes. B, Liver biopsy of the plaque (H:E x100). C, Lymph node biopsy (H:E x40). This figure appears in color at www.ajtmh.org.

Received June 6, 2008. Accepted for publication June 25, 2008.

^* Address correspondence to Fouad N. Boctor, Laboratory Medicine M.C. 01-31, Geisinger Medical Center, 100 N. Academy Ave., Danville PA 17822. E-mail: fnboctor{at}Geisinger.edu

Authors’ addresses: Fouad N. Boctor, Laboratory Medicine, M.C. 01-31, Geisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, Tel: 570-214-8063, Fax: 570-271-6105, E-mail: fnboctor{at}Geisinger.edu. Sundara R. Sridhar, Department of Pathology, Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, NY 11235, E-mail: sridhar126{at}yahoo.com.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Boctor, F. N. Articles by Sridhar, S. R. Search for Related Content PubMed PubMed Citation Articles by Boctor, F. N. Articles by Sridhar, S. R.