Background: Tuberculosis (TB) is the most common opportunistic infection in persons living with human immunodeficiency virus (HIV) worldwide. In the United States, the incidence of TB in 2009 was 4.1 per 100 000, with 10% of the patients coinfected with HIV. An estimated 10 to 15 million people in the United States have latent TB. Human immunodeficiency virus–related extrapulmonary TB is defined by the World Health Organization as an acquired immunodeficiency syndrome diagnosis. Extrapulmonary TB is found in approximately 20% of the patients with TB in the US, and the most common form is tuberculous lymphadenitis.
Case: We report the case of a 28-year-old man who emigrated from Mexico 8 years ago and presented to the emergency department with abdominal pain. The pain was described as 8/10 in intensity, constant, occasionally radiating to the back and associated with nausea, diarrhea, profuse night sweats, fatigue, and a 20-pound weight loss over a 2-week period. Result of the patient’s chest radiography was normal, and a computed tomographic scan of the abdomen revealed multiple soft tissue lesions in the upper abdomen that demonstrated low central density, suggesting necrotic lymph nodes. Mild ascites and subcentimeter lesions in the spleen representative of microabscesses were also reported. An HIV testing by enzyme-linked immunosorbent assay was positive, confirmed by Western blot, and the absolute CD4 count was 38. The patient’s history was revisited, and he disclosed having had multiple sexual partners. A Quantiferon test was negative. Endoscopic ultrasound (EUS)-guided core biopsy was obtained.
Conclusions: We present a case of abdominal lymphadenitis diagnosed through biopsy by EUS, rendering a diagnosis of TB in a patient with undiagnosed acquired immunodeficiency syndrome. An EUS-guided biopsy of accessible abdominal nodes presents a convenient technique through which specimens may be gathered for culture and pathologic examination. Our case points out that under circumstances where a high index of suspicion for extrapulmonary TB exists, EUS with fine needle aspiration can be a very important supplement to our diagnostic armamentarium.