(557) Caught off Guard: A Case of Disseminated Abdominal Tuberculosis Masquerading as a Metastatic Tumor

Tuesday, January 23, 2024

11:15 AM – 12:15 PM MT

Location: Connections Central - RST 01

First Author(s)

Sruthi Sekaran, MD, (she/her/hers)

Mercy Fitzgerald

Co-Author(s)

NC

Niranjini Chandrashekaran, MD

Resident Physician
n/a, United States
Bv

Beata vayngortin, n/a

Medical Student
Dextral University School of Medicine, United States
MC

Michelle Cho, MD

Resident Physician
Trinity Health- Mercy Catholic Medical Center, United States
MR

Manzoor Rather, MD

Program Director
Mercy Fitzgerald Hospital, United States
AS

Aisha Sultana Shaik

Resident- Physician
Mercy Fitzgerald Hospital
Darby, Pennsylvania
Rakin M. Rashid, MD

n/a
VM

Vidhi Mehta, MD

Resident Physician
n/a, United States

Introduction: HIV/AIDS confers an immunocompromised state that puts a patient at a higher risk of developing opportunistic infections. The risk of infections rises with reduced CD4 cell count and noncompliance with HAART. Of the 7874 TB cases reported in the US in 2021, only 7% were abdominal TB cases. In this report, we describe one such case of reactivated latent tuberculosis [LTB] in HIV.

Description: A 40-year-old female who immigrated to the USA, with no past medical history, presented with complaints of hematochezia, significant weight loss, and dull abdominal pain. In the ED she was tachycardic with a BP of 96/50, febrile to 103, and saturating at 98%. Labs showed Hb of 4.7, WBC-14.1, platelet-423, creatinine-2.3, eGFR-27, and lactate-1.2. She was admitted with a presumptive diagnosis of severe anemia secondary to lower GI bleed.
CTA abdomen showed signs of proctitis. Incidentally, several large hypoattenuating masses were seen in the root of the mesentery and enlarged retroperitoneal lymph nodes. These findings were concerning lymphoma v/s metastatic disease. CT chest showed hazy ground glass opacity throughout the bilateral lungs.
The patient underwent laparoscopy to biopsy the intra-abdominal mass and stage the tumor. Surprisingly, the mesenteric mass drained purulent material. Concurrently, her blood turned positive for AFB, and HIV PCR was positive with a high viral load and a CD4 count of < 50. The culture of the mesenteric abscess fluid grew Mycobacterium Tuberculosis with a negative sputum culture. She was then started on Rifampin, Isoniazid, Pyrazinamide, Ethambutol, and HAART and was discharged home successfully.

Discussion: The USA has 13 million people with LTB. The majority of the TB cases in the US are associated with HIV and foreign-born residents due to the reactivation of LTB. Abdominal TB can occur in the peritoneum, lymph nodes, solid organs, or the GI tract. Interestingly, TB lymphadenitis is the most common presentation in HIV/AIDS individuals. It can often masquerade as inflammatory bowel disease and malignancy until a biopsy proves otherwise. A high index of suspicion and early initiation of anti-tuberculosis therapy is imperative to prevent significant morbidity and mortality. Screening and eventually treating latent TB has to be emphasized to eradicate TB in the USA.