A 53 years old male presented with epigastric pain, anorexia and nausea for 3 months. He lost 10 kgs of weight in few months. There was no past or family history of tuberculosis. Patient was non-diabetic. Clinical examination was within normal limits. X ray chest, complete hemogram, liver and renal function tests were normal. HIV testing was negative. Upper GI endoscopy was suggestive of deformed and narrowed antrum, with gastric outlet obstruction. (Fig 1) Duodenum was also deformed. Abdominal CT scan revealed presence of multiple lymph nodes in para aortic, celiac, pancreatic and retroperitoneal regions. Barium meal studies were suggestive of deformed and spastic duodenum. Exploratory laparotomy was planned to relieve gastric outlet obstruction due to matted lymphnodes, which were causing extrinsic compression and obstruction of pylorus. Gastrojejunostomy was performed. Histopathology of the lymph node revealed caseating granuloma. He was put on ATT regimen of (HERZ) 2(HR) 7 during which, he gained weight of 12 kgs and became symptom free. Upper GI endoscopy at 6 months was normal with presence of GJ stoma.
A 23 years female presented with epigastric pain, vomiting and loss of weight for last 6 months. Her upper GI endoscopy was suggestive of narrowed antrum and gastric outlet obstruction. She underwent laparotomy for relieving gastric outlet obstruction with gastrojejunostomy. Intraoperatively a lymph node mass was seen obstructing pyloroduodenal region which on histology was suggestive of caseating granuloma with presence of acid fast bacilli. Then she received ATT that is (HERZ) 2(HR) 7 for 1 year and was symptom free. Five years later, she presented again with splenomegaly and imaging studies were suggestive of portal hypertension with calcified portal cavernoma and splenomegaly. Liver was normal on imaging as well as on scintigraphy. Her hemogram, liver and renal function tests and chest X ray were normal. Viral and autoimmune markers were negative. She was a nondiabetic and negative for HIV serology. Upper GI endoscopy revealed esophageal and fundic varices and presence of gastrojejunal stoma. Portal vein thrombosis in this case was probably secondary to old tubercular lymphadenitis.
A 32 years male presented with epigastric pain and occasional vomiting for 1 year. He did not show any response to repeated antisecretory medications. There was no past or family history of tuberculosis. Clinical examination was normal. X ray chest, liver and renal function tests were normal. Patient was non-diabetic and seronegative for HIV. Upper GI endoscopy was suggestive of nodular ulcerative lesion at gastro esophageal junction, occluding almost half of the lumen. Endoscopic biopsy revealed caseating epitheloid granuloma with Langhan's giant cells. CT scan abdomen was suggestive of enhancing nodular lesion in celiac and para aortic regions, probably lymph nodes with asymmetrical thickening of wall at gastro esophageal junction. Patient was put on ATT regimen of (HERZ) 2(HR) 7 and became symptom free. Repeat upper GI endoscopy at one year was normal.
A 30 years male presented with epigastric pain and dysphagia of five months duration. Upper GI endoscopy was suggestive of a mass at gastro esophageal junction with possibility of leiomyoma. There was no response to antisecretory medications. Patient did not give any past or family history for tuberculosis. Clinical examination was normal. X ray chest, hemogram, liver and renal function tests were normal. Abdominal CT scan revealed heterogeneously enhancing lesion at gastro esophageal junction. Repeat upper GI endoscopy was suggestive of an ulcer at gastro esophageal junction and evidence of gastritis. Endoscopic biopsy showed multiple caseating granulomas suggestive of tuberculosis. He was put on ATT regimen of (HERZ) 2(HR) 7 and became symptom free.