Molecular and Histopathologic Evidence for Systemic Infection by Mycobacterium Bovis in A Patient with Tuberculous Enteritis, Peritonitis, and Meningitis: A Case Report

Abstract

Mycobacterium bovis infection has been reported in several patients with AIDS in other countries. The prevalence of tuberculosis in Taiwan is higher than the World Health Organization standard. However, reports of M. bovis infection are rare. A 47-year-old male had the habit of drinking uncooked fresh deer's blood and unpasteurized deer's milk. He suffered from acute abdominal pain and underwent emergency laparotomy. Pathology demonstrated tuberculosis enteritis with colon perforation. The molecular diagnosis by nested polymerase chain reaction assay and single-strand conformation polymorphism assay showed M. bovis infection in the small intestine, mesenteric lymph nodes, and cerebrospinal fluid (CSF). Our results suggest that the most likely portal of entry of M. bovis is the gastrointestinal rather than the respiratory tract. Ingested M. bovis from unpasteurized deer's milk probably entered the mucosal macrophages of the intestine and then the draining mesenteric lymph nodes. As immunity declined, bacilli from the mesenteric lymph nodes disseminated to other organs and into the CSF.

Keywords

• enteritis
• peritonitis
• meningitis
• Mycobacterium bovis