[Acute appendicitis and gastrointestinal tuberculosis with negative thoracic X-ray and positive sputum culture]

A case of gastrointestinal tuberculosis is presented with negative radiographic findings in the thorax and positive results of culture of the sputum. The value of radiographic examination of the thorax for demonstration of tuberculosis is briefly discussed on the basis of the literature. Normal radiographic findings in the thorax do not exclude gastrointestinal tuberculosis. Radiographic examination of the thorax only reveals active pulmonary tuberculosis in approximately 50% of the patients with gastrointestinal tuberculosis. Pulmonary tuberculosis with positive sputum culture can be demonstrated in up to 50% of the patients with gastrointestinal tuberculosis. Most frequently, demonstration of acid-fast rods or positive culture from biopsy specimens or material obtained at laparotomy cannot be anticipated. Opinions differ as to whether histological evidence of tuberculosis in the form of caseous granulomata occurs frequently in gastrointestinal tuberculosis. The greatest chance of demonstration is to be found in the lymph nodes draining the region concerned. This was the case in the patient presented here where caseous necrosis and epithelioid cell granulomata were demonstrated.