Rare Case of Lower Gastrointestinal Bleeding Secondary to Miliary Tuberculosis in the United States

TL;DR

This case report describes a rare instance of gastrointestinal bleeding caused by miliary tuberculosis in a U.S. patient without lung symptoms.

Contribution

The paper presents a unique clinical case of gastrointestinal miliary TB and emphasizes the need for increased awareness in immigrant populations.

Findings

Miliary TB can present as gastrointestinal bleeding without pulmonary symptoms.

Surgical intervention was required due to failed embolization in this case.

The patient's outcome was fatal despite anti-tuberculosis treatment.

Abstract

Tuberculosis (TB) remains a significant global health challenge. Miliary TB is a rare manifestation of TB that involves systemic lymphohematogenous dissemination of infection and presents diagnostic challenges due to its often asymptomatic or non-specific nature. This case report documents a rare occurrence of gastrointestinal (GI) bleeding secondary to miliary TB without pulmonary symptoms in an 81-year-old Filipino-American male living in the United States. Extensive imaging studies revealed a mass in the right colon with multiple bleeding vessels draped around it; it was not amendable to treatment with embolization and required right hemicolectomy with end ileostomy. The pathology report of the excised mass demonstrated miliary TB with necrotizing granulomas and granulomatous lymphadenopathy involving 23 lymph nodes. The patient was started on anti-tuberculosis medical management; however, the patient remained clinically unstable and expired on postoperative day 39. This case highlights the importance of the heightened clinical awareness required during times of globalization and in regions with dense immigrant populations. We aim to delineate the clinical understanding of gastrointestinal TB (GITB) and review possible indications for surgical management. We aim to help reduce diagnostic delay, therefore improving patient outcomes and limiting the spread of disease.

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