Pulmonary tuberculosis presenting as post-operative fever of unknown origin

BMJ Case Rep. 2017 Jan 6:2017:bcr2016216329. doi: 10.1136/bcr-2016-216329.

Abstract

Post-operative fever is common following emergency surgery. Investigation and management of post-operative fever can be challenging when a clear source of sepsis is not evident or the underlying source of infection is not recognised. We herein report a case of secondary pulmonary tuberculosis presenting as post-operative fever following emergency laparotomy for a perforated duodenal ulcer. This case of tuberculosis was diagnosed on day 41 post-operatively and prior inconclusive results meant that we relied mainly on re-visiting history and examination in order to identify 3 targeted investigations: plain chest X-ray, sputum sample and blood test. Accordingly, the co-management of this complex patient achieved a good outcome.

Publication types

  • Case Reports

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Delayed Diagnosis
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Duodenal Diseases / diagnostic imaging
  • Duodenal Diseases / surgery
  • Fever of Unknown Origin / microbiology*
  • Humans
  • Intestinal Perforation / diagnostic imaging
  • Intestinal Perforation / surgery
  • Male
  • Middle Aged
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / etiology
  • Pneumoperitoneum / diagnostic imaging
  • Pneumoperitoneum / etiology
  • Postoperative Complications / diagnosis
  • Postoperative Complications / drug therapy
  • Postoperative Complications / microbiology*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tuberculosis, Pulmonary / complications*
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy

Substances

  • Antitubercular Agents