# Two Cases of Intestinal Tuberculosis With Severe and Fatal Gastrointestinal Bleeding: Is the Indication for Intravenous Therapy Essential?

## TL;DR

Two cases of intestinal tuberculosis with severe bleeding show that intravenous therapy may be more effective than oral treatment for managing the condition.

## Contribution

The study highlights the potential necessity of intravenous therapy in managing severe gastrointestinal bleeding in disseminated tuberculosis.

## Key findings

- A patient with HIV/AIDS and intestinal tuberculosis died despite oral treatment and endoscopic intervention.
- Another patient improved significantly after switching to intravenous therapy and showed healing on follow-up colonoscopies.

## Abstract

These two cases involve two patients with intestinal tuberculosis and severe lower gastrointestinal (GI) bleeding. The first case was a young woman who lived with HIV/AIDS and disseminated tuberculosis with wasting, pulmonary, and abdominal involvement that, despite the usual tuberculostatic treatment, evolved with a massive GI bleed. Her colonoscopy showed granulomatous colitis with active bleeding, and her biopsy showed positive acid-fast bacilli, confirming the diagnosis. Despite oral tuberculosis and endoscopic hemorrhage control therapies, the patient suffered recrudescent bleeding, evolved to refractory hemorrhagic shock, and died. The other case was that of a young man with no immunological impairment who had disseminated tuberculosis with intestinal impairment. This patient developed severe lower GI bleeding after six days of oral therapy and was subsequently transitioned to full intravenous (IV) treatment. Follow-up colonoscopies were performed after two weeks and one month of IV therapy. The first examination revealed ulcers covered with fibrinous layers and no signs of recent bleeding, while the second showed almost complete healing of the lesions. The patient demonstrated clinical improvement with no recurrence of bleeding and was discharged for outpatient follow-up after a total of three months of hospitalization. These two clinical cases highlight the importance of a precocious diagnosis, as well as the right interventions in patients with disseminated tuberculosis with GI involvement, emphasizing the importance of intravenous therapy over oral therapy.