The digestive system is affected in 66-75% of patients with abdominal TB. Various pathogenesis are involved; swallowing of sputum with direct seeding, hematogenous spread, or (although rarely today) ingestion of milk from cows affected by bovine tuberculosis.3
A male, 27 years old, came with a chief complaint abdominal pain for over one month. He also got diarrhea 3-4 times a day, weak consistency, unpleasant odor, brownish color. He suffered the diarrhea for over a month. He also got fever, nausea, loss of body weight, and loss of appetite. There was history of smoking, about 6 cigarettes a day. There was no cough or other pulmonary complaints.
On physical examination, he looked pate, 39.5 kg of body weight, the Body Mass Index was 14.36 (underweight), axillary temperature was 39.5oC. tachycardia (120 bpm), increased of intestinal motility, and abdominal pain in almost all of quadrants.
Laboratory result showed hypochromic microcytic anemia (Hemoglobin 8.3 g/dL, MCV 77.9 fL, MCH 23.9 pg, MCHC 30.6 g/dL). High blood precipitate rate (65 mm/hour), low hematocrit (27.1%), AST/ALT 81U/L / 36U/L, negative Salmonella thypi 0, positive H 1/80, negative parathypi A and B. Colitis representation on USG.
He was admitted for further work up and was diagnosed with observation of febrile, colitis and hypochromic microcytic anemia. The first day of admission, he was treated with intravenous fluid, thiamphenicol 3x500 mg and symptomatic treatments.
The second day of admission, anti-HTV test and feces analysis were done with negative anti IIIV result and positive blood, mucus, fat, and bacteria in feces analysis. The third day of admission, there wass no progress in his condition. Chest x-ray done with military tuberculosis result, standard 4-drug antituberculosis therapy was initiated for a 6-month course. Unfortunately, he wanted to be out patient without permission. We suggested him to consume die antituberculosis drugs every day.