Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6537
Peer-review started: September 27, 2020
First decision: October 18, 2020
Revised: October 24, 2020
Accepted: November 4, 2020
Article in press: November 4, 2020
Published online: December 26, 2020
Processing time: 83 Days and 1.4 Hours
Primary duodenal tuberculosis is very rare. Due to a lack of specificity for its presenting symptoms, it is easily misdiagnosed clinically. Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome.
A 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain. Initial imaging examination revealed a duodenal space-occupying lesion; subsequent upper abdominal contrast-enhanced computed tomography indicated duodenal malignant tumor. Physical and laboratory examinations showed no obvious abnormalities. In order to confirm further the diagnosis, electronic endoscopy was performed and tissue biopsies were taken. Duodenal histopathology showed granuloma and necrosis. In-depth tuberculosis-related examination did not rule out tuberculosis, so we initiated treatment with anti-tuberculosis drugs. At 6 mo after the anti-tuberculosis drug course, there were no signs of new development of primary lesions by upper abdominal computed tomography, and no complications had manifested.
This case emphasizes the importance of differential diagnosis for gastrointestinal diseases. Duodenal tuberculosis requires a systematic examination and physician awareness.
Core Tip: Tuberculosis is a major threat to human health, and its incidence continues to rise, especially in developing countries. The gastrointestinal form of tuberculosis, however, is rare. We report here the case of an elderly male, whose primary duodenal tuberculosis was misdiagnosed as tumor. Despite the imaging diagnosis of malignant tumor, tissue biopsy did not support that diagnosis. After a series of additional tests, the patient was treated with anti-tuberculosis drugs for a period of 6 mo. Follow-up showed no new disease progression and no other complications. This case emphasizes the importance of differential diagnosis of duodenal space-occupying disease.