Infectious colitis - Tuberculous colitis – Example 1
This 48-year-old male with cardiomyopathy had been treated for many years with prednisone. At a follow-up examination, a tumor of about fist-size was palpated. Ultrasound identified enlarged lymph nodes in the lower right quadrant that could not be separated from the colon and terminal ileum. CRP was strongly elevated. The initial suspected diagnosis was lymphoma.
The video begins in the cecum. Bauhin’s valve is widely opened and passage of the endoscope into the terminal ileum is easily accomplished. Macroscopically, the ileal mucosa resembles that of the colon with clearly visible vessels. The cecum showed broad necroses with areas of preserved mucosa.
Biopsies showed acid-fast bacilli. This finding was later confirmed by culture. The clinically palpable tumor is a finding frequently encountered in tuberculosis in this area. The differential diagnosis must include Crohn’s disease and NSAR colopathy. The tumor disappeared slowly during therapy. (see also Videoclip 2)