Yehya Elficki
Gastric tuberculosis is an uncommon site of extrapulmonary tuberculosis infection; clinically gastric tuberculosis resembles peptic ulcer disease or less likely a gastric malignant growth. We report a case of an endoscopic large gastric mass in an HIV negative immunocompetent male patient secondary to pulmonary tuberculosis presented with severe chronic abdominal pain and vomiting found to have a large tuberculoma at the fundus of the stomach, follow up endoscopy after 12 month of antituberculous treatment showed remnants of fibrotic bands with complete recovery of the patient from his pulmonary as well as the extra pulmonary gastric TB. This case report highlight the utility of endoscopic brush smears in the diagnosis of tuberculosis in clinically suspected cases and necessity of application of Z-N stain smear on endoscopic brush cytology as a reliable and simple modality for the diagnosis of gastric tuberculosis Tuberculosis (TB) is a common public health problem in many parts of the world and despite being almost 100% curable, TB is still a leading cause of morbidity and mortality worldwide, representing second most common cause of death from infectious disease globally after HIV. Involvement of the heart with TB occurs in one to two percent of patients with TB, TB myocarditis may occur by hematogenous, lymphatic spread or directly from the contagious structures like pericardium. Commonest site involved is the pericardium, and tuberculous involvement of the myocardium was thought to be extremely rare. However, the rarity of myocardial TB and TB DCM nee ds to be reconsidered in the literature and research work, since the reported cases of myocardial TB in many different parts of the world was found in the last decades with different modalities of diagnosis (including endomyocardial biopsies, the delayed enhancement MRI technique of imaging of the myocardium or by clinical suspicion and diagnosis), or at autopsies. Different forms and presentations of TB (either pulmonary or extra pulmonary TB like TB synovitis) may end up with further extra pulmonary fatal complication as TB-DCM during the course of illness and during recovery. This makes TB-DCM an under- diagnosed entity that should be focused on for prevention and/or early diagnosis, and management. In addition, the actual prevalence of TB myocarditis and TB-DCM may explain a modest percentage of mortalities in TB patients, together with the paradoxical anti TB medications response phenomenon (Immunorestitution),where pulmonary or extra pulmonary TB lesions improve while paradoxical deterioration of cardiac muscle contractility and development of dilated Cardiomyopathy occurs, as been observed in the chronological sequence of events in our case study as well as in many similar case reports, proving again that "many diseases are there, while the physicians are not yet".