By Tedler D. Depaynos, MD
The patient used to be “macho looking” but when he came home after working for quite some time in the South, he apparently has “reduced in size” and his facial bones became more prominent. He was with his usual self however, when he joined his relatives digging for the evasive yellow metal. Actually he was still envied because he brought home an industrious pretty lady whom they considered a “foreigner” in their jokes because she could not speak their local “Ibaloi” dialect.
It was more than a month ago when he began experiencing persistent low grade fever with slight body malaise. Despite his uncomfortable feeling, he kept on with his usual heavy work. He began however to start losing his appetite despite the hard work and his abdomen appeared to be becoming firm. His bowel movements became irregular, once every two or three days but no loose stools. He finally decided to follow his wife’s pleadings to seek medical consult when he started getting weaker.
At the emergency room, some of the more elderly MDs immediately entertained the possibility of “tuberculosis” or “TB” just by the “facial” look of the patient despite the negative history of chronic cough. The possibility of a late stage malignancy was also immediately considered.
Because the fever was more than a month, tests for dengue and typhoid fever were included in the routine blood tests. Chest x-rays and abdominal ultrasounds were also done. Surprisingly the results were essentially normal or with not so significant findings.
His abdomen however became more rigid and tender so that the attending MDs concluded that it is where the main pathology of the patient originated. He was referred to a Gastroenterologist who recommended a CT Scan worked up for a more definitive diagnosis. When this was explained to the patient with the possibility that he will undergo surgery after, the patient together with his relatives, however, decided that the diagnostic test procedure be cancelled and surgery should immediately be done. The patient was in pain and besides the procedure was beyond their budget.
The walls of the intestines were reddish implying that they were inflamed and closely filled with mongo-like nodules including the peritoneal layer. They were adherent to each other and when the young operating surgeons tried to separate them, they were afraid that they would be torn and perforation may result. One of the surgeons who happened to be a lady exclaimed that she had seen two or three similar cases in her youthful practice and they all turned out to be due to “tuberculosis” by biopsy. An elderly surgeon who happened to be around just smiled which was noticed by a lady intern despite his mask.
The lady surgeon emphasized then that although “tuberculosis” or TB is transmitted thru the lungs, extra pulmonary cases like probably the case of this patient is also common. It may affect the bones which is termed Pott’s disease and may affect the head and may be termed TB Meningitis. She could even recall the patient who had a non-painful skin lesions oozing with pus all over his body for the past four years who turned out to be due to TB. In these cases, biopsies are needed to confirm the diagnosis unlike in pulmonary cases where sputum examinations and chest x-rays may be confirmatory.
Anti-TB drugs was given to this patient but for healing to occur may take a longer time. In some cases, the intake of the anti-TB medicines may last for a year and complications like intestinal adhesions causing obstruction may sometimes happen. **
