Two patients with intestinal failure requiring home parenteral nutrition, a NOD2 mutation and tuberculous lymphadenitis

BMC Gastroenterology

Case Report

Chih-Jen Hsieh¹  Matthias Teufel²  Sabrina Fleischer²  Holger Schäffler³  Georg Lamprecht³  Julia-Stefanie Frick⁴ 

[1] 1st Medical Department, University of Tübingen, Tübingen, Germany;Department of Diagnostic Radiology, Eberhard Karls University Tübingen, Tübingen, Germany;Division of Gastroenterology, Department of Medicine II, University of Rostock, Ernst-Heydemann-Str. 6, D-18057, Rostock, Germany;Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany;

关键词: NOD2;    Intestinal failure;    Tuberculous lymphadenitis;    Catheter related blood stream infection;   

DOI  :  10.1186/1471-230X-14-43

 received in 2013-10-26, accepted in 2014-02-20,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMutations in the NOD2 gene are a significant risk factor to acquire intestinal failure requiring home parenteral nutrition. Tuberculous lymphadenitis is the main manifestation of extrapulmonary tuberculosis. Defects in the innate immunity, including NOD2 mutations, may increase the risk for acquiring infections caused by M. tuberculosis. An association of intestinal failure, mutations in the NOD2 gene and tuberculous lymphadenitis has not been described before.Case presentationWe report of two patients with intestinal failure secondary to mesenteric ischemia. Both patients presented with fever and weight loss while receiving long term home parenteral nutrition. Both of them were found to have mutations in the NOD2 gene. Catheter related infections were ruled out. FDG-PET-CT scans initially obtained in search for another infectious focus that would explain the symptoms unexpectedly showed high FDG uptake in mediastinal lymph nodes. Direct or indirect evidence proved or was highly suggestive for tuberculous lymphadenitis. Intravenous tuberculostatic therapy was started and led to a reversal of symptoms and to resolution of the lesions by FDG-PET-CT.ConclusionMutations in the NOD2 gene may put patients both at an increased risk for acquiring M. tuberculosis infections as well as at an increased risk of intestinal failure after extensive intestinal resection. Thus we suggest to specifically include reactivated and opportunistic infections in the differential diagnosis of suspected catheter related infection in patients with intestinal failure who carry mutations in their NOD2 gene.

【 授权许可】

Unknown   
© Schäffler et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.