Disseminated tuberculosis mimicking metastatic gastric cancer - a case report

• Published in: Zeitschrift fur Gastroenterologie Vol. 57; no. 12; p. 1487
• Main Authors: Voit, Florian Maximilian, Abdelhafez, Mohamed, Rothe, Kathrin, Slotta-Huspenina, Julia, Gaa, Jochen, Schmid, Roland M, Spinner, Christoph Daniel
• Format: Journal Article
• Language: German
• Published: Germany 01-12-2019
• Subjects: Aged; Antitubercular Agents - therapeutic use; Biopsy; Diagnosis, Differential; Gastric Mucosa - microbiology; Gastric Mucosa - pathology; Germany; Humans; Male; Mycobacterium tuberculosis - isolation & purification; Stomach Neoplasms - pathology; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Miliary - diagnosis; Tuberculosis, Miliary - drug therapy; Tuberculosis, Miliary - microbiology; Tuberculosis, Osteoarticular - diagnosis; Tuberculosis, Osteoarticular - drug therapy; Tuberculosis, Osteoarticular - microbiology; Tuberculosis, Spinal - diagnosis; Tuberculosis, Spinal - drug therapy; Tuberculosis, Spinal - microbiology; Germany
• ISSN: 1439-7803
• DOI: 10.1055/a-1030-4781

Increasing numbers of active tuberculosis in Germany were recorded in the last years. Thus, also extrapulmonary manifestations of tuberculosis gain clinical significance as differential diagnoses, especially when a metastatic tumor disease is suspected. We report the case of a 77-year-old male patient who presented with unilateral leg pain and B symptoms. Further investigations revealed an osteolytic mass in the sacrum as well as CT-morphological findings consistent with metastatic gastric cancer. However, transgastric biopsies showed necrotising granuloma with giant cells leading to molecular and cultural detection of Mycobacterium tuberculosis instead of suspected neoplastic tissue. A nine-month treatment regimen for suspected disseminated tuberculosis with bone involvement was initiated according to national guidelines. Clinical and radiological follow up examinations after treatment completion showed complete remission.