Asymptomatic Tuberculosis-Induced Ileal Perforation in an HIV- Infected Individual; A Case Report

Abstract

The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation.

Keywords: Acquired Immune Deficiency Syndrome (AIDS).; Human Immunodeficiency Virus (HIV); Intestinal perforation; Tuberculosis.

Fig. 1

Radiographic findings of chest; A. Vague bilateral nodular pattern in the chest X-ray taken one week prior to admission; B. Obvious nodular pattern in both lungs and an incidentally detected free air under both hemidiaphragms

Fig. 2

Abdominopelvic computed-tomographic  demonstration of pneumoperitoneum

Fig. 3

The depth of a skin ulcer after primary debridement