Foregut tuberculosis: Too close but miles apart

Table 3 Duodenal tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Mani and Rananavare[56]	18-year-old man	Persistent vomiting due to duodenal stricture as shown in endoscopy	Underwent laparotomy and resection. Post-surgical specimen revealed tuberculosis granulomas
De et al[57]	38-year-old woman	Recurrent vomiting	CT showed mural thickening of duodenum, deeper endoscopic biopsies revealed non-necrotizing granulomata. Treated with ATT
Naouri et al[58]	69-year-old man	Duodenal stenosis	Misdiagnosed as Crohn’s disease
Sato et al[60]	35-year-old man	Abdominal fullness, vomiting, CT showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph node	EUS-FNA biopsy of duodenum showed caseating granulomas with multinucleated giant cells, and AFB were positive by Ziehl–Nielsen staining. Underwent laparoscopic gastrojejunostomy, and ATT after surgery
Antón Rodríguez et al[61]	60-year-old woman	Weight loss, bloating, duodenal thickening on CT scan	Endoscopic biopsy showed granulomatous inflammation and positive PCR for MTB. Treated with ATT
Chang et al[62]	52-year-old man	Early satiety, post meal abdominal pain, weight loss	Duodenal tissue culture showed growth of MTB. Treated with ATT
Pratap et al[63]	43-year-old woman	Nausea, vomiting, fever, weight loss	Duodenal ulcer on endoscopy with biopsy showing active duodenitis and positive AFB stain, lymph node biopsy also confirmed TB. Treated with ATT
Dahiya et al[64]	23-year-old man	Post-prandial fullness, weight loss	Duodenal narrowing on endoscopy. Duodenal segment resection with duodenojejunostomy, biopsy showed granulomatous inflammation suggestive of TB
Zhang et al[65]	71-year-old man	Upper abdominal pain	Space occupying lesion on CT scan, endoscopic biopsy showed granulomas. Treated with ATT
Moirangthem et al[66]	17-year-old man	Gastric outlet obstruction	Underwent laparotomy which revealed duodenal mass. Biopsy showed caseating tuberculosis
Berney et al[67]	22-year-old man	Duodenal ulcer perforation	Underwent laparotomy. Margins of ulcer were resected. Biopsy showed giant-cell-granulomatous inflammation. Lymph node biopsy showed caseating necrosis
Souhaib et al[68]	33-year-old woman	Perforated duodenal ulcer which was initially diagnosed as acute cholecystitis	Underwent laparotomy. Peri-duodenal lymph node and the gallbladder lymph node showed caseating necrosis
Sharma et al[69]	32-year-old man	Recurrent vomiting, weight loss, thickened duodenum seen on CT scan and endoscopy	Histopathology revealed features of chronic inflammation, giant cells, and granulomas. Ziehl–Nielsen stain of tissue specimens was positive for AFB. Treated with ATT for 8 months

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; CT: Computed tomography; EUS: Endoscopic ultrasound; FNA: Fine needle aspirate; MTB: Mycobacterium tuberculosis; PCR: Polymerase chain reaction.