Abstract:
:Infections caused by pathogens of the Mycobacterium tuberculosis complex, i. e., tuberculosis (TB), and the non-infectious, autoimmune disease sarcoidosis are among the most common granulomatous diseases worldwide. Typically, the lung is the primary site of infection and manifestation, respectively which makes the two diseases important differential diagnoses. Both diseases can affect virtually all organ systems, albeit with significantly lower incidence. CASE PRESENTATION: We report the case of a 50-year-old Indian man presenting with a tuberculous perihepatic abscess and a systemic inflammatory response after being diagnosed with neurosarcoidosis presenting as a single granuloma in the frontal lobe with lymphadenopathy in 2014. On day of admission the patient presented with right upper abdominal pain and fever for two weeks. With increased inflammatory parameters in serum and after finding of external CT images, a perihepatic abscess was suspected. This encapsulated cave was drained percutaneously under CT control. A high concentration of acid-fast rods was detected using ZN, PCR was positive for M. tuberculosis. Several samples of sputum and urine were microscopically negative but yielded growth of Mycobacteria after four weeks. DISCUSSION: This is a case presenting with two different granulomatous diseases, each of which manifested itself in an atypical form. The tuberculous liver abscess might either be explained as a flare-up of latent tuberculosis under azathioprine therapy or as a reinfection acquired during one of several visits in the high-prevalence country India. In addition, it must be discussed whether the cerebral granuloma in 2014 could have been an early stage of tuberculous granuloma. Sensitivity of ZN staining is significantly reduced in cerebral samples, and negative PCR-results might be due to low germ load or methodical issues, e. g., decreased sensitivity in formalin fixated samples. :Infektionen ausgelöst durch pathogene Mykobakterien des Mykobakterium tuberculosis-Komplexes (wie beispielweise die Tuberkulose) oder die Autoimmunerkrankung Sarkoidose, zählen zu den häufigsten granulomatösen Erkrankungen weltweit. Typischerweise kommt es bei beiden Entitäten zunächst zu einem pulmonalen Befallsmuster, was wiederum eine Stellung als gegenseitige Differentialdiagnose mitbedingt. Eine Ausbreitung auf multiple Organsysteme ist möglich (wenn auch mit deutlich geringerer Inzidenz verbunden). FALLVORSTELLUNG: Wir berichten den Fall eines 50-jährigen indischen Mannes, der sich mit einem perihepatischen tuberkulösen Abszess und einer systemischen Entzündungsreaktion vorstellte, nachdem 2014 eine Neurosarkoidose bei singulärem Granulomnachweis im Frontallappen und begleitender Lymph-adenopathie diagnostiziert worden war. Am Aufnahmetag berichtete der Patient über seit zwei Wochen bestehende rechtsseitige abdominelle Beschwerden und intermittierende Fieberschübe. Nach CT-gesteuerter Drainierung des perihepatischen Abszesses erbrachten PCR und Ziehl-Neelsen Färbung den Nachweis von Mykobakterium tuberculosis. Auch die angelegten Sputum- und Urinkulturen wurden nach vier Wochen positiv. DISKUSSION: Bei dem Patienten kam es vermutlich zur sequentiellen Erkrankung mit zwei verschiedenen granulomatösen Entitäten, die sich beide auf eine atypische Art und Weise klinisch manifestierten. Die neu aufgetretene Tuberkulose könnte dabei entweder mitbedingt durch die immunsuppressive Wirkung des Azathioprins, eingesetzt zur Behandlung der 2014 diagnostizierten Neurosarkoidose oder im Rahmen eines Indienaufenthalts neu entstanden sein. Möglicherweise hatte es sich auch bereits 2014 um ein frühes Stadium eines tuberkulösen zerebralen Granuloms gehandelt und eine reduzierte Sensitivität der Ziehl-Neelsen Färbung bzw. eine damals negative PCR-Testung bei reduzierter Sensitivität der in Formalin fixierten zerebralen Biopsate hatte eine Diagnostik konterkariert.
journal_name
Z Gastroenteroljournal_title
Zeitschrift fur Gastroenterologieauthors
Gernert JA,Sirtl S,Macke L,Wittmann E,Strueven AK,Schwarze V,Dichtl K,Neumann J,Mayerle J,Schulz Cdoi
10.1055/a-1330-9046subject
Has Abstractpub_date
2021-01-01 00:00:00pages
50-55issue
1eissn
0044-2771issn
1439-7803journal_volume
59pub_type
杂志文章abstract:INTRODUCTION: Assessment of disease activity in Crohn's disease (CD) and ulcerative colitis (UC) is usually based on the physician's evaluation of clinical symptoms, endoscopic findings, and biomarker analysis. The German Inflammatory Bowel Disease Activity Index for CD (GIBDICD) and UC (GIBDIUC) uses data from patient...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-0605-4080
更新日期:2018-10-01 00:00:00
abstract::The role of endogenous gastrin in the pathogenesis of "idiopathic" ulcer disease is difficult to determine; however, gastrin is probably only of limited importance besides various probable more important factors. In conditions associated with uncontrolled gastrin production by a gastrin secreting tumor or in cases in ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::A 61-year-old white female with chronic hepatitis C virus (HCV) infection first diagnosed in 1994 was admitted with two newly discovered lesions in the liver suspected to represent hepatocellular carcinoma. The alpha-1-fetoprotein (AFP) level was within normal limits and there was neither clinical nor sonographic evid...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1996-05-01 00:00:00
abstract:PURPOSE:Hepatocellular carcinoma (HCC) is one of the major malignancies worldwide. For most patients with advanced or multifocal HCC treatment options are limited resulting in a poor prognosis. Several local ablation methods have been developed as minimally invasive strategies for HCC treatment. It is unclear, until no...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2003-44304
更新日期:2003-11-01 00:00:00
abstract::Non-resectable cholangiocarcinoma and gallbladder carcinoma have a poor prognosis. In addition to the general aspects of "best supportive care", biliary drainage is an important part of the palliative treatment of patients with malignant biliary stenosis. Photodynamic therapy has led to an improved median survival in ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2006-926869
更新日期:2006-07-01 00:00:00
abstract::Background: Acute hepatitis B virus (HBV) infection is still a major cause of acute liver failure (ALF), necessitating a high rate of emergency liver transplantation (LTx). Acute infection is followed by high viral replication rates leading to hepatocyte death and, ultimately, ALF. The objective of treating HBV-induce...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0042-120418
更新日期:2016-12-01 00:00:00
abstract::Antimicrobial substances such as vancomycin or metronidazole suppress normal gut flora, thereby preventing physiological fermentation of colonic substrates that may promote mucosal inflammation. This study was designed to establish an in vitro model of microbial metabolism in the colon under control and disturbed cond...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2001-18537
更新日期:2001-11-01 00:00:00
abstract::The phenomenon of the spontaneous parietal cell sensitivity not induced by drugs is described in a number of gastric diseases. Different parietal cell sensitivity can be assumed. 1. when there is a shift in the dose response curve between the aid output and continuous intravenous application of a stimulant, 2. when th...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract:BACKGROUND:Helicobacter pylori is a human pathogen that causes chronic gastritis and peptic ulcers. Epidemiological studies demonstrated that individuals who are blood group 0 positive or represent non-secretors of their blood group antigens are more likely to develop peptic ulcers. The Lewis(b) blood group antigen has...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2002-30115
更新日期:2002-05-01 00:00:00
abstract::We present the case of a primary malignant esophageal melanoma arising in a 75-year-old male, initially diagnosed as anaplastic squamous cell carcinoma. After resection of the tumor, histological work-up was indicative of a marked morphological heterogeneity, resembling a focally amelanotic primary malignant melanoma....
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2005-858102
更新日期:2005-06-01 00:00:00
abstract::The oesophagus, stomach and pancreas are primary target organs for ethanol-related diseases. In the oesophagus and stomach, ethanol induces motility disorders and mucosal lesions that are dose-dependent and reversible under acute conditions. Chronic consumption of alcohol causes a significant increase in the risk for ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2005-858257
更新日期:2005-08-01 00:00:00
abstract::Humoral and/or cell-mediated (CMI) immune responses to HBAg components, human and rabbit liver specific proteins (HLP and RLP) and tuberculin were tested in patients with acute virus B and non-B-hepatitis, asymptomatic HBsAg carriers and HBsAg positive chronic active hepatitis (CAH). Furthermore, the presence of HBsAg...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1976-05-01 00:00:00
abstract::Gastric cancer and cancer of the oesophagogastric junction is diagnosed in the locally advanced or metastatic setting in 55 - 65 % of the cases and is generally treated with perioperative or palliative chemotherapy. For patients with metastatic disease, it is important to reliably determine the HER2 status for potenti...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0043-116493
更新日期:2017-09-01 00:00:00
abstract::Primary intestinal lymphangiectasia (PIL) is a protein-losing, exsudative gastroenteropathy causing lymphatic obstruction. Diagnosis depends on clinical examination and histological findings. Conservative treatment modalities include a low-fat diet and enteral nutritional therapy in order to reduce enteric protein los...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0031-1273473
更新日期:2013-06-01 00:00:00
abstract::Diathermocoagulation is indispensable in interventional endoscopy. The argon beam coagulation represents an innovative electrocoagulation method, where high-frequency alternating current is conducted to tissues by ionized argon gas without contact. Before clinical application we performed in vitro studies to evaluate ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract::Chronic hepatitis C virus infection can be associated with mixed cryoglobulinemia and systemic vasculitis. The pathogenesis remains poorly understood. 55 consecutive patients with chronic HCI infection (anti-HCV- and serum HCV RNA-positive) were studies prospectively. Cryoglobulinemia was detected in 28 patients (51%)...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::Assessment of the clinical value of the pancreolauryl test (PLT) in the literature range from "useless" to a specifity of 95% and a sensitivity of 98%. In this work, our own data are presented in relation to various reference methods. The results are derived from the largest collective investigated to data, comprising...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1984-12-01 00:00:00
abstract::Report about 5 cases with a chronic erosion with granulation tissue formation of the mucosa of the resected stomach in the gastroenterostomotic area. These lesions appeared endoscopically as discoloration, or as small elevation of the mucosa or as a distinct polyp. One case with a more extensive granulation tissue for...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1982-03-01 00:00:00
abstract::The role of bile acids and lysolecithin in the pathogenesis of peptic ulcer is as yet not unequivocally defined. Based on the physiochemical properties of bile acids and animal experiments they have damaging potential on the mucosal cell. However, the majority of results reported in patients do not favour a significan...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:
更新日期:1987-08-01 00:00:00
abstract::For many years ultrasound-guided biopsy and drainage has represented a routine part of clinical practice. Percutaneous biopsy and drainage are minimally invasive procedures for sampling tissue or the removal of fluid collections within the body. Differing image guidance techniques for the positioning of the needles/ca...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-0029-1245706
更新日期:2010-11-01 00:00:00
abstract::Successful application of non operative procedures for gallstone therapy are limited on cholesterol stones. Therefore reliable therapeutic analysis of stone components is mandatory for planning of an adequate therapy. Computed tomographic gallstone analysis is considered to improve selection of patients significantly....
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::The amino acid consumption test (AACT) during exogenous stimulation with secretin and CCK was proposed as a sensitive and highly specific test for detection of exocrine pancreatic insufficiency. To further investigate the diagnostic value of this test we measured the AACT in comparison with the pancreolauryl serum tes...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1992-06-01 00:00:00
abstract::Indication and significance of roentgenological procedures referring to esophageal and gastric motility are discussed with special reference to a number of functional disorders. Cinematography and tape-recording are necessary for fast peristaltic motion as in vascular, neurological and myogenic diseases of the upper e...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1977-03-01 00:00:00
abstract::Using precipitating antibodies to human liver alkaline phosphatase (L-AP), a quantitative method is evaluated for the determination of L-AP-activity in feces. Normal controls (n = 42) exhibit a logarithmic normal distribution. Patients with intrahepatic cholestasis (n = 36) demonstrate an increase, patients with extra...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1980-05-01 00:00:00
abstract::Although NSAID-induced colonopathy characterised by erosions, ulcers, strictures and diaphragms has been known for quite some time, it is not infrequently misinterpreted endoscopically and histologically as Crohn's disease. This is exemplified by the present case history of a 39-year-old man with bloody diarrhoea and ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0028-1109760
更新日期:2010-04-01 00:00:00
abstract::Since 1977, 15 patients have undergone surgery for Zenker's diverticula at the University of Würzburg Department of Surgery. We were able to follow up 6 of them after an average of 4 years (5 months to 10.5 years). Preoperative manometric findings available on one patient revealed markedly impaired coordination betwee...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1992-02-01 00:00:00
abstract::Patients with portal hypertension may develop pulmonary complications such as hepatopulmonary syndrome (HPS) or portopulmonary hypertension (PPHT). PPHT is defined as elevated pulmonary pressure, elevated pulmonary vascular resistance, a normal pulmonary capillary wedge pressure, and portal hypertension in the absence...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2005-857926
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND: The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. METHODS: Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years,...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-1217-7465
更新日期:2020-09-01 00:00:00
abstract::35 out of 57 patients with gastric carcinoma presented with a so called "target" pattern. In cases with distal cancer the more advanced cases with endoscopic types Borrmann III/IV showed this sign more frequently than less advanced forms, i.e. suspected early cancer, Borrmann I or Borrmann II. On the other hand in end...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1984-02-01 00:00:00
abstract::In 20 patients suffering from advanced chronic active hepatitis, type B or NANB, the therapeutic effect of cyclosporin A was studied. 15 of these patients already showed cirrhotic transformations and partial liver dysfunctions. In 15 cases an unsuccessful pretreatment with glucocorticoids and/or azathioprine had been ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1988-05-01 00:00:00