Experience with two cases of intestinal tuberculosis: utility of the QuantiFERON-TB Gold test for diagnosis

Background: Intestinal tuberculosis is rare in Western countries, with incidence rates of 35.7and 0.43 per 100,000 per year for the immigrant and native populations, respectively. Despitea clear increase in the frequency of extrapulmonary tuberculosis in immunosuppressed patients,the clinical features of intestinal tuberculosis are seen rarely. A typical clinical presentationincludes abdominal pain, weight loss, fever, weakness, nausea, vomiting, obstruction,and bleeding. Intestinal tuberculosis often mimics inflammatory bowel disease ormalignant neoplasia, and its preoperative diagnosis is a challenge. Microbiologic diagnosisoften is difficult because the causative microorganism requires a long incubation period.Methods: Two case reports and review of the pertinent literature.Results: We report two cases of colonic tuberculosis mimicking cecal carcinoma in one patientand periappendiceal abscess in the other. A 75 year-old man underwent right hemicolectomyfor a right colon mass. Preoperative laboratory, radiologic, and endoscopic evaluationswere negative for tuberculosis and carcinoma. The QuantiFERON-TB Gold test waspositive. Surgical specimen histologic review showed non-caseating granulomas and rareZiehl-Neelsen-positive bacilli. A 35 year-old man, born in Sri Lanka but living in Italy for 10years, came to our attention for a periappendiceal abscess. Multiple peritoneal micro-noduleswere found at laparotomy. Their extemporaneous histologic examination showed granulomasand giant-cell inflammation. A right hemicolectomy was performed. The QuantiFERON-TBGold test, performed on peritoneal fluid and blood, was positive in both.Conclusions: The QuantiFERON-TB Gold test may hold promise for use in intestinal inflammatorydiseases when tuberculosis is suspected but conventional workup is not diagnostic.