A 67-year-old woman had developed weakness, fatigue and a 10 kg weight
loss over the past year. On examination a cylindrical mass was palpat
ed in the right middle abdominal cavity. Erythrocyte sedimentation rat
e was increased to 87/126 mm, there was an hypochromic anaemia (haemog
lobin 9.1 mg/dl) and an hypoalbuminaemia (32 g/l) with an increase in
alpha(2)-globulins (9.4 g/l), Cholinesterase activity was decreased to
588 U/l. X-ray film of the abdomen revealed a calcified mesenteric ly
mph-node and coloscopy demonstrated polypoid tumorous changes with ulc
erations, extending from the pole of the caecum to the right flexure.
Histological examination showed epithelioid-cell granulomas with Langh
ans giant cells. Culture grew Mycobacterium tuberculosis, confirming t
he diagnosis of intestinal tuberculosis. She was treated with oral dos
es of isoniazid (300 mg daily), rifampicin (600 mg daily) and pyrazina
mide (2 g daily) for 2 months, followed by isoniazid and rifampicin fo
r a further 4 months. After this the laboratory tests were within norm
al limits and urine as well as stool samples contained no acid-fast ba
cilli. As the patient felt so well she declined another coloscopy.