DÄ internationalArchive9/2019Ogilvie Syndrome in Disseminated Tuberculosis

Clinical Snapshot

Ogilvie Syndrome in Disseminated Tuberculosis

Dtsch Arztebl Int 2019; 116(9): 145; DOI: 10.3238/arztebl.2019.0145

Krasselt, M; Lübbert, C; Exner, M

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Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone
Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone
Figure
Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone

A 25-year-old male student from Indonesia presented with weight loss, deterioration in performance, dyspnea, and vomiting. On the basis of radiographically demonstrable lung infiltrates, abdominal air–fluid levels, CT-morphological signs of small-bowel stenosis, and the demonstration of acid-fast rods (sputum, gastric juice), we diagnosed disseminated tuberculosis (TB) with mechanical ileus. An HIV test was negative. Six weeks of tuberculostatic treatment brought no clinical improvement, and there were increasing massively distended intestinal loops with refractory painful obstipation. Resistance testing was normal, so we suspected a TB immune reconstitution inflammatory syndrome and started prednisolone. This achieved a partial response and the small-bowel stenosis was no longer evident; however, the massively dilated loops of colon remained just as prominent (Figure). We diagnosed infection-associated Ogilvie syndrome, and following failure of neostigmine we used the serotonin (5-HT4) receptor agonist prucalopride, upon which intestinal function completely returned to normal. The term Ogilvie syndrome (acute colonic pseudo-obstruction) is used to describe a massively dilated, atonic large intestine. The cause probably lies in a functional disorder of the autonomic nervous system. If drug treatment fails, endoscopic decompression or (in rare instances) surgical treatment (resection, cecostomy) may be considered.

Dr. med. Marco Krasselt, Sektion Rheumatologie, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig

Dr. med. Marc Exner, Klinik für Diagnostische und Interventionelle Radiologie, Department für Diagnostik,
Universitätsklinikum Leipzig

Prof. Dr. med. Christoph Lübbert, D.T.M.&H., Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, christoph.luebbert@medizin.uni-leipzig.de

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Krasselt M, Exner M, Lübbert C: Ogilvie syndrome in disseminated tuberculosis. Dtsch Arztebl Int 2019; 116: 145. DOI: 10.3238/arztebl.2019.0145

Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone
Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone
Figure
Sagittal contrast-enhanced computed tomography of the abdomen after 6 weeks of tuberculostatic treatment followed by administration of prednisolone