A Case Report Of Intestinal Tuberculosis With Hepatic Tuberculosis, Tuberculous Peritonitis Tuberculous Pleuritis And Literature Review

Objective:To explore the etiology clinical characteristics, imaging tests,differential diagnosing of intestinal tuberculosis and hepatic tuberculosis, so as to improve the level of diagnosing and treatment.Methods:The clinical data of one patient suffered from intestinal tuberculosis with hepatic tuberculosis, tuberculous peritonitis, tuberculous pleuritis were retrospectively analyzed, and the literature were reviewed.Data:A young female patient, who had progressive abdominal distention, fatigue, emaciation for more than two months, abdominal distention increased and accompanied by fever, night sweats. Outpatient examinations showed ascites and pleural effusion.Interventions:To carry out the routine examination and chest X-ray, T-SPOT, abdominal paracentesis, ascites TB-DNA, whole abdominal enhanced computed tomography(CT), endoscopy, colonoscopy, gynecological B ultrasound, and pathological examination, so as to make the definite diagnosis. Meanwhile, supportive treatment included nutritional support to, immunity enhancement, and symptomatic treatment, was used. Give diagnostic anti-tuberculosis treatment after the comprehensive analysis combined with test results, close observation and follow-up.Results:Abdominal enhanced CT showed:1. right pleural effusion and limitation of the right lung lower lobe atelectasis, seroperitoneum, peritoneal thickening, mesenteric edema, combined with the medical history, tuberculous pleurisy and tuberculous peritonitis were considered;2. left lobe of liver abnormalities density, tuberculosis might was considered; colonoscopy shows ileocecal ulcers, intestinal tuberculosis was considered, pathologic examination showed chronic inflammatory changes in mucosal tissues of ileocecal. Diagnostic anti-tuberculosis treatment for6weeks was effective. Finally, the patient was diagnosed as intestinal tuberculosis with hepatic tuberculosis, tuberculous peritonitis, tuberculous pleuritis.Conclusion:There was no specific clinical manifestations of intestinal tuberculosis or hepatic tuberculosis, the comprehensive analysis on the basis of summarizing the PPD skin test, T-SPOT, ascites TB-DNA, colonoscopy, whole abdominal enhanced CT, histopathology and bacteriology ect, can improve the accuracy of diagnosis; experimental drug treatment when necessary.