ENDOSCOPIC DIAGNOSIS OF TUBERCULOSIS OF T HE COLON

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.