Diagnostic Dilemma - Pediatric Oncall
ILEAL PERFORATION IN A CHILD WITH DISSEMINATED TB
Author: Pediatric Oncall
Question
An 8 years old boy presented with dry cough and low grade fever for 6 months, constipation for 2 months with pain on left side of abdomen for 1 month. Uncle had tuberculosis and had died due to same. On examination, he had tenderness in left lumbar region and other systems were normal. He was malnourished with a weight of 14 kg. Chest X-Ray was normal. Ultrasound abdomen showed mild hepatosplenomegaly with long segment thickening of bowel and enlarged mesenteric lymphnodes. HIV ELISA was negative. He was started on antituberculous therapy {ATT}. Three months after ATT, he had ileal perforation and required surgery. A lymphnode biopsy did not grow any acid fast bacilli {AFB} after 6 weeks of culture. He was started on steroids in view of intestinal adhesions and responded to same.
Expert Opinion :
Corticosteroids are most commonly used for their anti-inflammatory properties to treat either the disease itself or occasionally the hypersensitivity reactions that occur with antituberculous drugs. Corticosteroids are frequently prescribed in gastrointestinal tuberculosis, although there is scant justification for their use. Intestinal strictures probably rarely complicate gastrointestinal tuberculosis treated with standard antituberculous drugs` corticosteroids may be helpful in reducing adhesions.
Answer Discussion :
S
SHOKRYcash
may be used
5 years ago
S
SRINIVAS RAVURI
steroids are not indicated in treatment of or for preventing intestinal adhesions
5 years ago
K
khuteja fatima
NO IT WOLD WORSEN THE CONDITION
DISSEMINATION OF TB and DELAYED HEALING OF PERFORATION OCCURS

5 years ago
S
SRINIVAS RAVURI
yes steroids can be used in such cases ,but only intestinal tuberculosis doesnt require steroids as aroutine
5 years ago
F
fificash ad
yes` in such severe cases give steroids with intensive anti-tuberculis therapy
5 years ago
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