Primary extrapulmonary tuberculosis diagnosis warrants extra-precautious pulmonary tuberculosis exclusion workup

Abstract

This editorial article takes an opportunity to apprehend the diagnostic challenges of primary gastrointestinal tuberculosis (an uncommon extrapulmonary tuberculosis condition) utilizing the recently published case report of a young male with prolonged gastrointestinal symptoms and weight loss who received intermittent anti-tubercular treatment and underwent operative interventions to relieve gastric outlet obstruction. The diagnosis chiefly relied on high-end examinations, like computed tomography scans and histopathological evaluation of post-operatively resected bowel tissue, which wasn't preceded by an all-inclusive stepwise primary pulmonary tuberculosis exclusion approach that usually begins with a detailed tuberculosis-pertinent history acquisition. Given the geographic locations where the patient had been (and/or treated), pivotal consideration of tuberculosis-associated endemicities in those regions, like human immunodeficiency virus (HIV) infection, might have improved the case description. The obtainment of HIV-relevant histories, like intravenous drug use and sexual practice, are good places to start. The sputum bacteriology also seems imperative to rule out atypical Mycobacterium species infection because of its clinico-radio-histopathological resemblance with pulmonary Mycobacterium tuberculosis. Altogether, this editorial aims to underscore that primary extrapulmonary tuberculosis diagnosis should comprise an elaborative, comprehensive, systematic, and stepwise primary pulmonary Mycobacterium tuberculosis exclusion workup.

Keywords: Extrapulmonary tuberculosis; Tuberculosis; Gastrointestinal; Diagnosis; Human immunodeficiency virus

Core Tip: The diagnosis of primary gastrointestinal tuberculosis due to Mycobacterium tuberculosis infection requires an overarchingly holistic stepwise case evaluation approach to exclude primary pulmonary tuberculosis rather than exclusively depending on high-end radiation-intensive expensive methods. Moreover, tuberculosis-relevant history-obtainment may not be limited to the disease-specific constitutional symptoms and signs. Instead, it may consider relevant factors like countries where the patient had been, tuberculosis contacts, nutrition, smoking and drinking habits, and weight loss. Additional primary pulmonary tuberculosis workup considerations can include important caveats in its diagnostic interpretations, like latent tuberculosis, atypical tuberculosis, and immunocompromised status.