SHM Converge Scientific Abstract ePoster Gallery-Bleeding Truths: Anticoagulation Uncovers Hidden Tb in Hiv

Pdf Summary

This case describes a 72-year-old man with newly diagnosed advanced HIV/AIDS (CD4 89, viral load 378,000) who presented with fatigue, dyspnea, and intermittent abdominal pain. His early workup was misleading: initial chest imaging suggested pneumonia, and abdominal symptoms were treated conservatively as possible partial small bowel obstruction or colitis/enteritis. He was later found to have pulmonary emboli, pulmonary nodules, and was started on anticoagulation.<br /><br />After developing hematochezia, colonoscopy revealed an ulcerated terminal ileum with adherent clots. Biopsy of the ileum showed granulomas and acid-fast bacilli, confirming gastrointestinal tuberculosis; Candida was also detected. Although sputum and bronchoalveolar lavage PCR tests were negative for TB, later sputum culture grew acid-fast bacilli, supporting pulmonary tuberculosis as well. He was started on RIPE therapy and antiretroviral treatment.<br /><br />The key lesson is that gastrointestinal tuberculosis should be considered in patients with advanced HIV who have unexplained abdominal pain or GI bleeding, even when respiratory studies are negative. Diagnosis often requires tissue biopsy with histology and PCR because symptoms are nonspecific and can mimic malignancy or inflammatory bowel disease. In this case, anticoagulation for pulmonary embolism revealed the hidden intestinal TB by triggering bleeding, which ultimately led to definitive diagnosis.

Asset Subtitle

Vineet Gupta

Meta Tag

Author List Aneesh Kuruvilla, Carlos Lago Hernandez, Lianne Chau, Vineet Gupta

Category Clinical Vignettes

Concept Gastrointestinal Tuberculosis

Concept Human immunodeficiency virus infection

Concept Tissue Biopsy

Concept Abdominal Pain

Concept Gastrointestinal Bleeding

Distinguished Non-Finalist

Presenter Organization University of California, San Diego (UCSD)

Presenting Author Vineet Gupta

Track Adult

Keywords

HIV/AIDS

gastrointestinal tuberculosis

terminal ileum

hematochezia

acid-fast bacilli

granulomas

pulmonary embolism

colonoscopy

RIPE therapy

antiretroviral therapy

Gastrointestinal Tuberculosis

Human immunodeficiency virus infection

Tissue Biopsy

Abdominal Pain

Gastrointestinal Bleeding