Zhang Y, Shi XJ, Zhang XC, Zhao XJ, Li JX, Wang LH, Xie CE, Liu YY, Wang YL. Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination: A case report. World J Clin Cases 2020; 8(24): 6537-6545 [PMID: 33392342 DOI: 10.12998/wjcc.v8.i24.6537]
Corresponding Author of This Article
Yun-Liang Wang, MD, PhD, Doctor, Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, No. 6 District 1, Fangxingyuan, Beijing 100078, China. yunliang_wang@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2020; 8(24): 6537-6545 Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6537
Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination: A case report
Yang Zhang, Xiao-Jun Shi, Xian-Cui Zhang, Xing-Jie Zhao, Jun-Xiang Li, Lin-Heng Wang, Chun-E Xie, Yu-Yue Liu, Yun-Liang Wang
Yang Zhang, Xiao-Jun Shi, Xian-Cui Zhang, Xing-Jie Zhao, Jun-Xiang Li, Lin-Heng Wang, Chun-E Xie, Yun-Liang Wang, Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
Yu-Yue Liu, Department of Pathology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
Author contributions: Zhang Y, Shi XJ, Zhang XC, and Zhao XJ participated in patient management; Zhang Y drafted the manuscript; Wang YL was the attending physician in charge of the patient, was responsible for the literature review and revised the article for important intellectual content; Wang LH performed the endoscopic examination for the patient; Liu YY performed the histopathological analysis; Li JX and Xie CE provided guidance for the case diagnosis.
Supported byFundamental Research Funds for the Central Universities (Scientific Research Innovation Team), No. 2019-JYB-TD004.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Liang Wang, MD, PhD, Doctor, Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, No. 6 District 1, Fangxingyuan, Beijing 100078, China. yunliang_wang@sina.com
Received: September 27, 2020 Peer-review started: September 27, 2020 First decision: October 18, 2020 Revised: October 24, 2020 Accepted: November 4, 2020 Article in press: November 4, 2020 Published online: December 26, 2020
Abstract
BACKGROUND
Primary duodenal tuberculosis is very rare. Due to a lack of specificity for its presenting symptoms, it is easily misdiagnosed clinically. Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome.
CASE SUMMARY
A 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain. Initial imaging examination revealed a duodenal space-occupying lesion; subsequent upper abdominal contrast-enhanced computed tomography indicated duodenal malignant tumor. Physical and laboratory examinations showed no obvious abnormalities. In order to confirm further the diagnosis, electronic endoscopy was performed and tissue biopsies were taken. Duodenal histopathology showed granuloma and necrosis. In-depth tuberculosis-related examination did not rule out tuberculosis, so we initiated treatment with anti-tuberculosis drugs. At 6 mo after the anti-tuberculosis drug course, there were no signs of new development of primary lesions by upper abdominal computed tomography, and no complications had manifested.
CONCLUSION
This case emphasizes the importance of differential diagnosis for gastrointestinal diseases. Duodenal tuberculosis requires a systematic examination and physician awareness.
Core Tip: Tuberculosis is a major threat to human health, and its incidence continues to rise, especially in developing countries. The gastrointestinal form of tuberculosis, however, is rare. We report here the case of an elderly male, whose primary duodenal tuberculosis was misdiagnosed as tumor. Despite the imaging diagnosis of malignant tumor, tissue biopsy did not support that diagnosis. After a series of additional tests, the patient was treated with anti-tuberculosis drugs for a period of 6 mo. Follow-up showed no new disease progression and no other complications. This case emphasizes the importance of differential diagnosis of duodenal space-occupying disease.
