ABSTRACT
We report on a 30-year old patient suffering from acute abdomen. X-ray examinations (abdomen photograph, passage of contrast medium) showed an obstructive ileus of the small bowel. Exploratory laparatomy revealed an obstruction of the small bowel by means of masses of lymphatic nodes as part of a mesenteric lymphadenopathy. M. tuberculosis was identified as growing in cultures of peritoneal smears and material of lymphatic nodes. The retrospective examination of the pre-operative x-ray photographs of the chest showed an old primary complex of the lung. A combination of four antituberculotic drugs: Rifampicin, ethambutol, isoniazid and pyrazinamid was administered following the concept of a 6-month regimen. This treatment was successful: CT-scans of the abdomen showed a reduction of the mesenterial lymphadenopathy and the disappearance of the duodenal impression in the follow-up after 4 weeks of therapy. The abdominal TBC represents a severe disease requiring a differential diagnostic distinction from other abdominal diseases such as ileitis terminalis, Crohn's disease, neoplass as especially gastrointestinal lymphomas, giardiasis, amoebiasis and yersinia enterocolitis. The disease has a special importance among immigrant populations.
Subject(s)
Abdomen, Acute/etiology , Intestinal Obstruction/etiology , Intestine, Small , Mesenteric Lymphadenitis/diagnosis , Peritonitis, Tuberculous/diagnosis , Tuberculosis, Lymph Node/diagnosis , Abdomen, Acute/pathology , Adult , Diagnosis, Differential , Humans , Intestine, Small/pathology , Lymph Nodes/pathology , Male , Mesenteric Lymphadenitis/complications , Mesenteric Lymphadenitis/pathology , Peritonitis, Tuberculous/complications , Peritonitis, Tuberculous/pathology , Tuberculosis, Lymph Node/complications , Tuberculosis, Lymph Node/pathology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/pathologyABSTRACT
A case is reported in which a patient with a rheumatoid factor-negative rheumatoid arthritis developed rheumatoid nodules in the penis during treatment with methotrexate. The development of rheumatoid nodules in seronegative rheumatoid arthritis patients is extremely rare. An acceleration of rheumatoid nodules in methotrexate-treated rheumatoid arthritis patients is reported in literature. Regarding the case reported here, we propose a causal relationship between methotrexate-treatment and the development of rheumatoid nodules in our patient. Methotrexate should not be the preferential treatment for patients with rheumatoid arthritis developing rheumatoid nodules and suffering from vasculitis.
