A Case of Colonic Tuberculous Perforation Associated with Corticosteroid Therapy for Scleroderma

Masatoshi Kajiwara, Yutaka Konishi and Tatehiro Kajiwara

Department of Surgery, Kobe City General Hospital

A 65-year-old woman treated with corticosteroid for scleroderma reported abdominal pain after corticosteroid-pulse therapy. Abdominal radiography showed free air below the diaphragm, necessitating emergency surgery for a diagnosis of gastrointestinal perforation. At laparotomy, we found a perforation with a deep ulcer on the opposite side of sigmoid colon attachment. Since radiography showed no pulmonary lesions, we confirmed the diagnosis of colonic tuberculosis by histological findings of the resected sigmoid colon, which showed typical granuloma with Langhans giant cells and acid-fast bacilli. She was prescribed 4 types of antituberculous drugs-INH, RFP, EB, and SM- and discharged. Postoperative colonoscopy showed circular ulcers that gradually improved. Cases of tuberculous perforation of intestine and colon have been reported, and this possibility should be considered when differentially diagnosing gastrointestinal perforation.

Key words
colonic tuberculosis, perforation, corticosteroid therapy

Reprint requests
Masatoshi Kajiwara Department of Surgery, Kobe City General Hospital 4-6 Minatojimanakamachi, Chuo-ku, Kobe, 650-0046 JAPAN

Accepted
February 26, 2003

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