A Case of Colonic Tuberculous Perforation Associated with Corticosteroid Therapy for Scleroderma

• Published in: Nippon Shokaki Geka Gakkai zasshi Vol. 36; no. 8; pp. 1232 - 1236
• Main Authors: Kajiwara, Masatoshi, Kajiwara, Tatehiro, Konishi, Yutaka
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2003
• Subjects: colonic tuberculosis; corticosteroid therapy; perforation
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.36.1232

A 65-year-old woman treated with corticosteroid for scleroderma reported abdominal pain after corticosteroid-pulse therapy. Abdominal radiography showed free air below the diaphragm, necessitating emergency surgery for a diagnosis of gastrointestinal perforation. At laparotomy, we found a perforation with a deep ulcer on the opposite side of sigmoid colon attachment. Since radiography showed no pulmonary lesions, we confirmed the diagnosis of colonic tuberculosis by histological findings of the resected sigmoid colon, which showed typical granuloma with Langhans giant cells and acid-fast bacilli. She was prescribed 4 types of antituberculous drugs-INH, RFP, EB, and SM- and discharged. Postoperative colonoscopy showed circular ulcers that gradually improved. Cases of tuberculous perforation of intestine and colon have been reported, and this possibility should be considered when differentially diagnosing gastrointestinal perforation.