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Vol. 5. Issue 4.
Pages 427-434 (July - August 1999)
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Vol. 5. Issue 4.
Pages 427-434 (July - August 1999)
CASO CLÍNICO/CLINICAL CASE
Open Access
Tuberculose multissistémica
Multisistemic tuberculosis
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S. Saldanha Coelho*, Ana Germano**, Alves Cardoso***
* Assistene Eventual do Serviço de Pneumologia do H. S. Marta (Director: Dr. Manuel Coelho)
** Interna do Internato Complementar do Serviço Imagiologia do H. S. José (Director: Dra Maria do Carmo Ribeiro)
*** Assistente Hospitalar Graduado do Serviço de Imagiologia do Hospital de S. José (Director Dra Maria do Carmo Ribeiro
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RESUMO

Apresentamos o caso clínico de um doente de vinte e urn anos, sexo masculino, raça branca, toxicodependente, que se queixou, no Serviço de Urgência, de febre, emagrecimento, dor abdominal e diarreia. Foi excluído o diagnóstíco inicial de apendicite. Baseados nos estudos radiológicos e endoscópicos, foi feito o diagnóstico de doença de Crohn ileo-cecal e iniciado tratamento com ácido 5-aminosalicílico e corticosteroides. Dada a má resposta clínics, foi adicionada 5-mercaptopurina. Seis semanas mais tarde. o doente ficou neutropénico e a febre reapareceu. Os radiogramas e tomografia computadorizada (TC) revelaram um derrame pleural direito e uma lesão cavitada nodular no segmento posterior do lobo superior do pulmão direito. Foi realizada uma biópsia pleural e foram identificados bacilos álcool-ácido resistentes (BAAR). Foi iniciado tratamento específico para a tuberculose e as imagens pulmonares desapareceram, mas a febre e as dores abdominais persistiram.

Após varios procedimentos diagnósticos, foi necessário realizar uma laparotomia. Foi confirmada uma ileíte terminal com fistula para o cólon sigmoide e feita uma colectomia parcial. Tinha adenomegalias meseotéricas nas quais foram identificados BAAR. O doente cumpriu dez meses de tratamento antibacilar e encontra-se bem.

REV PORT PNEUMOL 1999; V (4): 427-434

Keywords:
Palavras-chave
Ileite terminal
doença de Crohn
tuberculose intestinal
tuberculose multissistémica
ABSTRACT

We present the case report of a twenty one years old white male drug addict who complained in the Emergency Departement of fever, weight loss, abdominal pain and diarrhea. A first diagnosis of appendicitis was excluded. Based on radiologic and endoscopic studies a diagnosis of Crohn’s ileocecal disease was achieved and a treatment with 5-amino-salicilic acid and corticosteroid was started. There was a poor clinical response so 5-mercaptopurine was added. Six weeks later be became neutropenic and fever relapsed. The chest X- rays and computer tomogram (CT) revealed a right pleural effusion and a nodular cavitated lesion in the posterior segment of the upper right lung lobe. A pleural biopsy was performed and acid fast bacilii (AFB) were seen. Specific treatment for tuberculosis was started. The lung findings resolved but fever and abdominal pain persisted. After several diagnostic procedures a laparotomy was required. A terminal ileitis with a fistulous comunication to the sigmoid colon was confirmed and a partial colectomy was done. There was mesenteric lymph node enlargement and AFB ewere identified on biopsy material. The patient remains free of disease after 10 months.

REV PORT PNEUMOL 1999; V (4): 427-434

Key-words:
Terminal ileitis
Crohn’s disease
intestinal tuberculosis: multisistemic tuberculosis
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Copyright © 1999. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
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