Perforation of the Colon Caused By Intestinal Tuberculosis

Excerpt

To the Editor—We have read with interest the case report by Heinrich et al.1 concerning a case of retroperitoneal colon perforation as the result of intestinal tuberculosis in an immunocompetent man. We have, however, some concerns. Blood cultures or bone marrow aspirates were not mentioned, therefore, tuberculosis hematogenous spreading of miliary tuberculosis cannot be excluded, which unequivocally would prove the primary gastrointestinal origin. Intestinal tuberculosis is caused by ingestion of infected sputum or saliva, hematogenous spreading from lung or miliary tuberculosis, contaminated foodingestion, or from neighboring infected organs. Infection through contaminated food is uncommon today and is caused by Mycobacteriumbovis (Mycobacterium tuberculosis complex). M. bovis currently produces primary lung infection, and transmission can be via the aerial route.2 As a result, we believe that if an intestinal origin is supported, it is mandatory to show blood cultures, transbronchial biopsy, liver biopsy, and bone marrow aspirate, all of them with negative results for M. tuberculosis. …