A Case of Gastric Tuberculosis Mimicking Advanced Gastric Cancer
A 36-year-old male presented to the emergency room after 2 days of hematemesis and melena at volumes of approximately 300 cc. He had experienced epigastric pain and nausea for the last several days, but no other symptoms, including weight loss, were evident.\nThe patient had no past or family history of tuberculosis. He was a 16 pack-per-year-smoker, but was not a heavy drinker. He had lived in Seoul, where he was employed as an electrician. His physical examination proved unremarkable, revealing no lymphadenopathy and normal pulmonary findings. The abdomen of the patient was soft and was not tender, and a digital rectal examination revealed no blood. He had a normal body temperature, and exhibited stable vital signs. Laboratory data recorded a hemoglobin level of 10.6 g/dL, a white blood cell count of 9,400/mm3, platelet count of 185,000/mm3, an erythrocyte sedimentation rate of 2 mm/hr, and C-reactive protein < 0.8 mg/dL. Liver and renal function tests revealed normal findings. Tests for the viral markers of hepatitis and HIV were both negative.\nThe chest X-ray revealed no pathologic findings (). Gastroscopic findings on admission revealed a large, ulceroinfiltrative mass with irregular margins on the posterior wall of the high body (). Blood clots and exposed vessels as recently bleeding stigmata were observed. Additionally, converging and disrupted thickened folds were observed on the surrounding mucosa. Secondary gastroscopy after two days showed more prominent abnormalities of the marginal folds as cut, bitten, and converging shapes, although the clots and vessels had disappeared (). The bases of the irregular ulcers were uneven. These findings strongly suggested gastric malignancy. Consequently, biopsies were obtained from the described areas. A CT scan of the abdomen was conducted in order to rule out other malignant metastatic lesions. The CT scan revealed a thickening of the gastric upper body () with enlargement of the perigastric () and paraaortic lymph nodes (). The CT scan also revealed a mass lesion at the cecum and the ascending colon with pericolic fat infiltration and regional lymphadenopathies (). Colonoscopic examination revealed an ulceroinfiltrative lesion encircling the lumen of the ascending colon, through which the scope was unable to pass (). Endoscopic biopsies from the stomach and colon revealed noncaseating granulomas with no malignant cells, and detected no acid-fast bacilli (). However, the PCR tests for the detection of Mycobacterium tuberculosis from gastric and colonic biopsy specimens were positive. No culture tests were performed.\nAs the patient exhibited no more bleeding, he was treated conservatively, with antituberculous medications of isoniazide 400 mg, rifampicin 600 mg, ethambutol 800 mg, and pyrizinamide 1.5 g daily, beginning nine days after admission. On the follow-up endoscopic examinations, two and eight months after the start of this treatment, marked improvements were observed in the ulcerations with distortion of the mucosal folds at the high body of the stomach () and in the ascending colon (), respectively. On the CT scan performed after eight months of treatment, the previous lymphadenopathies were improved, and no more wall thickness was seen in the gastric and colonic areas. The patient is currently doing well, and antituberculosis treatment is being maintained with no side effects.