The patient was treated with combination of esomeprazole, amoxicillin, and clarithromycin (Nexium Hp7 Combination Pack containing selleck kinase inhibitor Nexium, Amoxil, Klacid,

Astrazeneca) for Helicobacter pylori eradication, and antituberculous therapy with isoniazid (Fawns & McAllan), rifampicin (Rifadin, Sanofi-Aventis), pyrazinamide, and ethambutol (Myambutol, Sigma Pharmaceuticals) was initiated after culture results returned positive. The patient experienced resolution of his symptoms after commencing treatment for MTB. Gastrointestinal TB is not infrequent and is reportedly the sixth commonest extrapulmonary site of infection, accounting for 3%–5% of all extrapulmonary disease.1 Although common in countries of high TB endemicity, the incidence of gastrointestinal TB in Australia is poorly documented. Gastrointestinal TB follows the swallowing of infected sputum, ingestion of contaminated milk or foods, hematogenous seeding from active pulmonary or miliary TB, or local spread from

adjacent organs.2–4 The small bowel and colon, in www.selleckchem.com/products/epacadostat-incb024360.html particular the terminal ileum, cecum, and ascending colon are commonly affected sites.1 Clinical manifestations in intestinal TB are often nonspecific and the clinical course can vary widely from an acute to chronic illness. Nonspecific chronic abdominal pain is the commonest complaint, present in 80%–90% of patients while fever, night sweats, and weight loss may also be present. Other gastrointestinal symptoms including diarrhea, constipation, per-rectal bleeding, and palpable right iliac fossa mass are varied.2,3 Small bowel obstruction5 and colonic perforation6 have also been reported. Showing the presence of MTB and granulomatous inflammation on histopathological examination, PCR7 and culture of mucosal biopsy specimens makes a definitive diagnosis of intestinal TB and is more useful than routine cultures alone. CT is useful in assessing intraluminal and extraluminal pathology, like bowel wall and mesenteric thickening, and abdominal

lymphadenopathy which can have features of hypoattenuation, peripheral rim enhancement, or calcification.8–10 Chest X-ray is nondiagnostic as <50% of patients with intestinal TB have evidence of pulmonary disease.10 (-)-p-Bromotetramisole Oxalate Colonoscopic findings are diverse and include macroscopic inflammatory changes, circumferential ulcerations, strictures, nodules, pseudopolyps, fibrous bands, fistulas, and deformed ileocecal valves.10,11 The differential diagnoses of intestinal TB include Crohn’s disease, lymphoma, adenocarcinoma, and other infective causes like amebiasis, actinomycosis, and Yersinia enterocolitica enteritis. In patients from countries of high MTB endemicity, the challenge lies in distinguishing intestinal TB from Crohn’s disease as both diseases have overlapping clinical, radiological, endoscopic, and histopathological features.