Case Report: Comorbidity of Tuberculosis pulmonal, Tuberculosis abdomen and amoebiasis

Andree Kurniawan1 Thania2

Faculty of medicine, Pelita Harapan University, Tangerang, Banten, Indonesia.1

Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten,
Indonesia2

Introduction
Tuberculosis is a kind of infectious disease caused by Mycobacterium tuberculosis. These
bacteria can arise in the lung and extrapulmonary. Pulmonary TB in Indonesia is still a
significant public health problem. Some time that these bacteria appeared in many other parts
of the body, one of them is abdominal tuberculosis. Entamoeba histolytica is a parasite
classified as intestinal protozoa, usually lives as commensal (apathogenic) microorganism on
the tissue of the human colon, but in the specific condition, it can be pathogenic by forming a
colony on the intestinal wall and by penetrating the abdominal wall which leads the condition
to be ulceration.

Case Illustration
A 19-year-old female presents with hematochezia four days prior, the patient complains of
weakness for one week, and fever for one week accompanied by chronic cough, and a
significant weight loss. On physical examination, the patient looked pale with icteric sclera,
epigastric tenderness, lower limb + / +. Laboratory findings show leukocytosis, microcytic
anemia, hypoalbuminemia. On sputum examination, tuberculosis +2 bacteria were detected,
increased in total bilirubin, and direct bilirubin. Investigation of the chest x-ray revealed the
presence of infiltrates in the upper and middle fields of the left lung, as well as the infiltration
under the right lung. On examination of the supine AP abdominal x-ray, air-fluid levels
(ascites) were seen, on stool examination, the slym consistency was found with + amoeba

Conclusion

From the reports claim by patients supported by physical examination and the existence of
supporting examinations, namely examination of sputum and x-ray of the thorax, it can be
concluded that the patient has pulmonary tuberculosis. Other comorbid diseases such as
abdominal tuberculosis can be diagnosed with symptoms and physical examination for ascites
and gold standard abdominal examination for hypoalbuminemia. Other comorbidities during
the microscopic stool examination found the entamoeba histolytic parasite, which is the cause
of the patient's bloody stools.