Human immunodeficiency virus infection and intestinal tuberculosis: a case report

Abstract

Opisujemo tridesetdvogodišnjeg bolesnika zaraženog HIV-om koji se razbolio pet mjeseci prije prijema u Kliniku s progresivnim mršavljenjem, febrilitetom i dijarejom. Zadnja 4 dana prije prijama osjetio je jače bolove u trbuhu. U času prijama u bolnicu bio je afebrilan, orijentiran, usporen, blijed, afoničan, klonuo, kahektičan i nepokretan. Abdomen je bio mekan, difuzno lagano osjetljiv na palpaciju. Opće stanje je bilo teže poremećeno. Na rendgenogramu pluća bila su obostrano prisutna inhomogena zasjenjenja. Postupno se razvijao akutni abdomen te je bolesnik operiran, nađeno je više perforacija na tankom i debelom crijevu, uz sterkoralni peritonitis. Učinjena je resekcija dijela terminalnog ileuma, desna hemikolektomija, ileotransverzalna terminoterminalna anastomoza i jejunostomija. Patohistološkom pretragom nađena je granulomatozna upala s kazeoznom nekrozom u stijenci tankog i debelog crijeva. Bolesnik je imao 11 limfocita CD4+ u mikrolitru krvi, te HIV-1 viremiju određenu metodom PCR od 1 480 000 kopija u mililitru plazme. Liječen je uspješno antituberkuloticima i kombinacijom antibiotika uz antiretrovirusno liječenje i parenteralnu i enteralnu alimentaciju. Privremena jejunostoma zatvorena je 3 mjeseca po prvoj operaciji, a 8 mjeseci potom bolesnik ima uobičajenu tjelesnu težinu (ukupno je dobio 35 kg). PCR HIV1 RNK je tada bila nedektabilna, a apsolutni broj limfocita CD4+ iznosio je 163/μL plazme.We present a case of a thirty-two-year-old HIV infected patient who presented with a 5 months history of weight loss, fever and diarrhea. Four days before admission he started to experience abdominal pain. On admission to the hospital the patient had no fever was pale, cachectic and immobile. The abdomen was diffusely tender on palpation. His general condition was poor. Achest X-ray upon the admission showed bilateral inhomogenous infiltrations. The patient developed clear signs of acute abdomen. Surgery was performed and multiple perforations of the small and large intestine were found together with a stercoral peritonitis. The terminal ileum was partially removed, a right hemicolectomy with a terminoterminal ileotransversal anastomosis and a jejunostomy were performed. Patohistological examination of the intestine revealed granulomatous inflammation of the small and large intestine areas of caseous necrosis. The CD4 lymphocyte count was 11 per microliter and the plasma HIV viral load measured by PCR showed 1 480 000 copies per milliliter. The patient was successfully treated with antituberculous drugs and other antimicrobials together with antiretrovirals. Parenteral and enteral alimentation was also given. The temporary jejunostomy was closed three months after the first operation. Eight months after the operation the patients regained his normal body weight (weight gain: 35 kg). HIV1 RNA was at that time undetectable and his CD4+ lymphocyte count was 163/μL