Foregut tuberculosis: Too close but miles apart

Table 2 Gastric tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Eray et al[40]	42-year-old woman	Loss of appetite, post-prandial epigastric pain, weight loss	Post- operation (on prediagnosis of gastric cancer) biopsy of tissue showed caseating granulomatous inflammation. TB PCR was positive. Treated with ATT
Zhu et al[41]	25-year-old woman	Upper abdominal discomfort and distension	EUS along with biopsy revealed granulomatous inflammation. PPD skin test was positive. Treated with ATT for 1 year
Zhu et al[41]	52-year-old woman	Upper abdominal pain and swelling for 6 months, 3 kg weight loss over 2 months, low-grade fever and night sweats for 1 week	EUS followed with biopsy showed granulomatous inflammation with caseous necrosis. Treated with ATT for 13 months
Zhu et al[41]	16-year-old man	Upper abdominal pain and fatigue for 3 months along with 4 kg weight loss	Biopsy post ESD (done with suspected diagnosis of interstitial tumor) showed caseous granuloma. PPD skin test was positive. Treated with ATT for 6 months
Seetlani et al[43]	55-year-old man	Persistent episodes of nonbilious vomiting and epigastric pain for 3 months, associated with weight loss	Endoscopic biopsies showed epithelioid cell granulomas. Multiple solid enhancing lymph nodes were seen on CT Abdomen. Treated with ATT for 6 months
Lv et al[44]	60-year-old woman	Endoscopy from another hospital showed smooth protruding lesion from gastric cardia	ESD performed (due to suspicion of gastric stromal tumor) followed with biopsy showed caseous necrosis. TB PCR was positive. Treated with ATT
Yan et al[45]	53-year-old woman	Upper abdominal pain and discomfort for 4 years	Histological analysis post laparoscopic surgical resection (due to suspected gastric tumor) showed granulomatous inflammation. GeneXpert MTB was positive
Lim et al[46]	38-year-old woman	Epigastric discomfort for 1 month along with palpable abdominal mass	Endoscopic biopsy showed necrotic granuloma with an abscess. AFB stain and PCR were positive for MTB. Due to resistance kanamycin, moxifloxacin, prothionamide and cycloserin and pyrazinamide were given for 1 year
Ma et al[47]	26-year-old woman	Constant gastric pain for 1 month accompanied with acid reflux	Gastroscopic biopsy showed caseous granuloma. MTB PCR was positive. Treated with ATT for 18 months
Talukdar et al[48]	30-year-old woman	Epigastric pain for 1 year along with progressive loss of appetite and 15 kg weight loss	Thickened gastric wall on CT scan. Endoscopic biopsy showed epithelioid granuloma with caseation. Ziehl–Nielsen staining of the biopsy specimen revealed AFB
Manoria et al[49]	39-year-old woman	Epigastric pain for 1 month accompanied with 3 kg weight loss	Endoscopic biopsy revealed multiple granulomas with epithelioid cells and multinucleate cells. Mantoux test was positive. Treated with ATT
Sharma et al[50]	21-year-old woman	2-day history of acute abdominal pain with bouts of hematemesis. CT showed gastric perforation	Biopsy post emergency distal gastrectomy revealed tuberculosis granulation tissue and acid- fast bacilli in the ulcer
Zhang et al[51]	40-year-old woman	Painful enlarged cervical lymph nodes for 2 weeks	Gastroscopic biopsy showed chronic granulomatous inflammation. AFB was positive. Treated with ATT for 6 months
Liu et al[52]	68-year-old man	Epigastric pain for a few months	Subtotal gastrectomy (suspected tumor) followed by histopathological examination revealed necrotizing granulomatous inflammation. MTB PCR was positive
Liu et al[53]	52-year-old woman	Upper abdominal pain for 6 months	Endoscopic biopsy showed caseous granuloma. Acid-fast stain and MTB PCR were positive
Khan et al[54]	29-year-old man	Epigastric pain for 1 month with 7 kg weight loss	Endoscopic biopsy specimen revealed caseating granulomas with AFB. Positive cultures for MTB

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; CT: Computed tomography; EGD: esophagogastroduodenoscopy; ESD: Endoscopic submucosal dissection; MTB: Mycobacterium tuberculosis PCR: Polymerase chain reaction; PPD: Purified protein derivative.