Diagnostic Dilemma


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.

Should ileal TB be treated with steroids_?
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 :
may be used
12 years ago
steroids are not indicated in treatment of or for preventing intestinal adhesions
12 years ago

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