Revisiting tuberculosis as a cause of gastric outlet obstruction:Insights from a case report

Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Performance of QuantiFERON(R)-TB Gold In-Tube assay in children receiving disease modifying anti-rheumatic drugs

Background:To evaluate the performance of theQuantiferon(R)-TB Gold In-Tube (QFT-IT) interferon (IFN)-7 assay for the detection of latent tuberculosis infection (LTBI)in children receiving anti-rheumatic treatment in a tertiary referral hospital of Northern Greece.Methods:A total of 79 consecutive children receiving anti-rheumatic treatment [of which 18 screened prior to antitumor necrosis factor (TNF)-α treatment] were tested using Mantoux tuberculin skin test (TST) and QFT-IT.Association of both tests with risk factors for latent tuberculosis and Bacillus Calmette-Guerin immunization was determined.Influence of age,TNF-α inhibitors,systemic corticosteroids,conventional disease modifying anti-rheumatic drugs (DMARDs) and total duration of therapy on the QFT-IT mitogen-induced response was evaluated.Results:Agreement between TST and QFT-IT results was moderate (k=0.38).Frequency of QFT-IT indeterminate results was low (2.5%).In patients with risk factors for LTBI,the odds of a positive IFN-7 assay was increased by a factor of 27.6 (P=0.002),whereas there was no positive TST.There was a significant difference in the mitogeninduced IFN-7 secretion among various treatments (P=0.038).TNF-α inhibitors were associated with increased mitogen-induced IFN-7 secretion compared to monotherapy with conventional DMARDs (P=0.008).All children screened prior to anti-TNF-a treatment exhibited a negative QFT-IT and no active TB disease was detected during a 2-year follow-up.Conclusions:QFT-IT may be a more reliable test than TST for detection of LTBI in children with rheumatic diseases receiving anti-rheumatic treatment.Drug regimen might influence the mitogen-induced IFN-γ secretion and the effect of TNF-α inhibitors might vary according to the specific agent administered.