Document Type : case report
Authors
1 MD, Pediatrics, Senior Resident, Department of Pediatrics, Maulana Azad Medical College,Lok Nayak & Associated Hospitals, University of Delhi, New Delhi, India.
2 MD, Associate Professor, Department of Pediatrics, Maulana Azad Medical College, Lok Nayak & Associated Hospitals, University of Delhi, New Delhi, India.
Abstract
Background: Gastrointestinal tuberculosis can have a plethora of presentations, commonly abdominal discomfort, altered bowel habits, weight loss, fever, or mild rectal bleeds. Massive and recurrent life-threatening Lower Gastrointestinal Bleeding (LGI) is an unusual presentation in mild-moderate hemophilia cases. Our case is a moderate hemophilia patient with a significant recurrent GIT bleeding where ileocecal tuberculosis was identified later as the culprit.
Clinical Description: We report an uncommon case of recurrent episodes of life-threatening LGI bleeding in a patient with moderate hemophilia A. The child was given factor VIII replacement therapy with each episode of bleeding. The radionuclide scintigraphy revealed the ileal origin of the bleed and contrast CT abdomen showed features suggestive of ileocaecal tuberculosis which was confirmed later microbiologically.
Management and Outcome: The patient showed significant improvement after the use of anti-tubercular drugs and achieved complete remission.
Conclusion: An alternate diagnosis concurrent to the non-severe form of hemophilia should always be sought as a possibility in case of severe spontaneous and recurrent LGI bleeding.
Keywords
- Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB. Ileal tuberculosis presenting as a case of massive rectal bleeding. Clinical and Experimental Gastroenterology. 2009 Nov 19:129-31.
- Kuka WP, Rakiro J, Gatheru J, Riunga F, Rajula A. Intestinal Tuberculosis Presenting with Gastrointestinal Bleeding in Patient on Warfarin Therapy. Case Reports in Gastrointestinal Medicine. 2022;2022(1):9277789.
- Pickles CW, Biss T, Bitar R. Gastrointestinal bleeding in children with hemophilia A. Clinical Pediatrics. 2018 Jun;57(7):854-6.
- Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R, Sahni P, et al. Differentiating Crohn’s disease from intestinal tuberculosis. World journal of gastroenterology. 2019 Jan 1;25(4):418.
- Mizuki A, Tatemichi M, Nagata H. Management of diverticular hemorrhage: catching that culprit diverticulum red-handed!. Inflammatory Intestinal Diseases. 2018 Dec 5;3(2):100-6.
- Tinsa F, Essaddam L, Fitouri Z, Brini I, Douira W, Becher SB, et al. Abdominal tuberculosis in children. Journal of pediatric gastroenterology and nutrition. 2010 Jun 1;50(6):634-8.
- Tsai HC, Lee SS, Wann SR, Chen YS, Wang JS, Chen ER, et al. Recurrent gastrointestinal bleeding due to a tuberculous mycotic aneurysm with an aortoduodenal fistula. International journal of infectious diseases. 2007 Mar 1;11(2):182-4.
- Pattanashetti N, Gupta S, Rana S, Dahiya D, Das A, Kumar V, et al. Intestinal tuberculosis: a rare case of massive gastrointestinal bleed in a post-renal transplant recipient. Indian Journal of Nephrology. 2019 Mar 1;29(2):132-4.
- Peyvandi F, Garagiola I, Young G. The past and future of haemophilia: diagnosis, treatments, and its complications. The Lancet. 2016 Jul 9;388(10040):187-97.
- Khan AU, Mandiga P. Gastrointestinal Bleeding Scan.2019.
)