Continuing Medical Education Abdominal tuberculosis: An unusual presentation Rinkesh Kumar Bansal a , Pankaj Tyagi a , Ashish Kumar a , Praveen Sharma a , Bansal Naresh a , Singla Vikas a , Anil Arora a,* , Seema Rao b a Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, Delhi, India b Department of Histopathology, Sir Ganga Ram Hospital, Delhi, India article info Article history: Received 28 September 2014 Accepted 31 October 2014 Available online xxx Keywords: Tuberculosis Erythema nodosum Ziehl Neelson abstract Tuberculosis is a very common disease in India. It can present in many ways, common as well as uncommon. The high level of suspicion is required, especially to diagnose in un- common presentation, so that morbidity and mortality can be prevented. Erythema nodosum (EN) is an inflammatory disease of the skin and subcutaneous tissue that may be found in infectious diseases like tuberculosis, sarcoidosis, Behc ¸ et disease, inflammatory bowel diseases, lymphoma and drug therapy. Here we present a case of young male with tubercular protein hypersensitivity reactions as a presenting feature of abdominal tuberculosis. Copyright © 2014, Sir Ganga Ram Hospital. Published by Reed Elsevier India Pvt. Ltd. All rights reserved. 1. Introduction Hypersensitivity reaction to tubercular protein can be the first and only presentation of tuberculosis in a patient with or without evidence of active disease. These hypersensitivity reactions can be of various types like erythema nodosum, phlyctenular conjunctivitis, pleural or pericardial effusion and reactive polyarthritis. 2. Case report A 45 year old male admitted in our hospital with complaints of multiple non-pruritic painful nodules over both legs without any joint involvement associated with reddish discoloration of left eye since 7 days. No history of fever, weight loss, cough or expectoration. There was no history of any contact of tuberculosis in the family. There was no history of significant drug ingestion. There was no history of similar episode or any drug rash in the past. On general physical examination, there was no pallor, icterus, cyanosis or lymphadenopathy. On local examination, multiple erythematous, papulo-nodular tender lesions of 1e1.5 cm size over both legs, more on the extensor surface (Fig. 1) and there was congestion of left conjunctiva (Fig. 2). Respiratory, cardiovascular, abdominal and central nervous system exami- nation were within normal limits. On vital examination, his pulse rate was 80/min, blood pressure was 110/80 mm Hg, temperature was 37.6  C and respiratory rate was 20/min. On investigations, Hemoglobin was 16.5 g/dl, TLC e 11100/ ml and platelet count e 2.19 lakh/ml. Renal and liver function test were normal. ESR was 73 and Mantoux was positive. ANA, Anti-ds DNA, c-ANCA and p-ANCA were negative. Chest X-ray was normal. * Corresponding author. E-mail address: dranilarora50@gmail.com (A. Arora). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/cmrp current medicine research and practice xxx (2014) 1 e3 http://dx.doi.org/10.1016/j.cmrp.2014.11.003 2352-0817/Copyright © 2014, Sir Ganga Ram Hospital. Published by Reed Elsevier India Pvt. Ltd. All rights reserved. Please cite this article in press as: Bansal RK, et al., Abdominal tuberculosis: An unusual presentation, Current Medicine Research and Practice (2014), http://dx.doi.org/10.1016/j.cmrp.2014.11.003