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Endoscopic and histological diagnosis of a case of disseminated tuberculosis with intestinal affectation and lipomembranous fat necrosis
Diagnóstico endoscópico e histológico de un caso de tuberculosis diseminada con afectación intestinal y necrosis grasa lipomembranosa
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Yebra Carmona, P. de María Pallares, L. Blasco Santana" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Yebra Carmona" "email" => array:1 [ 0 => "yebra.jorge@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "de María Pallares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Blasco Santana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico endoscópico e histológico de un caso de tuberculosis diseminada con afectación intestinal y necrosis grasa lipomembranosa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 806 "Tamanyo" => 89604 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This case concerns a 49-year-old woman from the Philippines who has been residing in Spain for the last few years and who has a history of chronic kidney disease undergoing dialysis. The patient was being studied for fever of unknown origin and recurrent pneumonia for the last 6 months with inconclusive results. The patient underwent positron emission tomography/computed tomography, which revealed hypermetabolic uptake at multiple levels (including cervical lymph nodes, lungs, liver and cecum). During the colonoscopy, we observed a patulous ileocecal valve, with punched-out mucous ulcers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histologically, these corresponded to extensively ulcerated intestinal mucosa, with clusters of epithelioid macrophages, giant cells and acid–alcohol-resistant bacilli isolates detected with Ziehl-Neelsen staining (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> [H&E 100×]. Inset: magenta intracellular bacillary structures [Ziehl-Neelsen 1000×]). Among the granulomas, we observed hyaline-crenulated membranes characteristic of lipomembranous fat necrosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>; H&E 400×). The polymerase chain reaction for <span class="elsevierStyleItalic">M. tuberculosis</span> was positive. These findings enabled the diagnosis of disseminated tuberculosis, which would not have been possible with other procedures, including direct smears for bacilli and fibrobronchoscopy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Intestinal tuberculosis is a chronic infection caused mainly by the bacteria <span class="elsevierStyleItalic">M. tuberculosis</span>. The disease usually develops after pulmonary involvement by the swallowing of sputum. Clinically nonspecific, this condition can present as chronic abdominal pain, diarrhea, constipation or febricula. Intestinal tuberculosis mainly affects the ileocecal valve and terminal ileum and is indistinguishable from Crohn's disease. Histologically, the disease is characterized by caseous epithelioid granulomas with giant cells. Lipomembranous fat necrosis is an uncommon phenomenon that has recently been reported in this infection. Polymerase chain reaction is highly specific (95%) although insensitive (47%), and therefore a negative result does not rule out the diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-11-07" "fechaAceptado" => "2018-11-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Yebra Carmona J, de María Pallares P, Blasco Santana L. Diagnóstico endoscópico e histológico de un caso de tuberculosis diseminada con afectación intestinal y necrosis grasa lipomembranosa. Rev Clin Esp. 2020;220:141–142.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 806 "Tamanyo" => 89604 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 171920 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 210131 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000002/v1_202002180732/S2254887419300104/v1_202002180732/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000002/v1_202002180732/S2254887419300104/v1_202002180732/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300104?idApp=WRCEE" ]
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