PMC8243228_01
A: Electronic microphotography (x40) showing chronic granulomatous mesoappendicitis and a pseudotumoral lesion which corresponds to granulomas (circle in dotted line). B: Electronic microphotography (x40) showing Langhans multinucleated giant cells inside the granuloma (blue arrows). No caseous necrosis was seen. Ziehl-Neelsen smear for Acid Fast Bacilli was negative.
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TB was made ( Figures 1- 3). Based on this result quadruple anti-tuberculous treatment (isoniazid 5 mg/kg, rifampicin 10 mg/kg, ethambutol 20 mg/kg, pyrazinamide 25 mg/kg) was initiated in concordance with Peruvian and international guidelines.  ,  
A: Electronic microphotography (x40) showing small bowel with chronic granulomatous inflammation, caseous necrosis (black circle) and Langhans multinucleated giant cells (blue arrows). B: Electronic microphotography (x40) showing Langhans multinucleated giant cells (blue arrows); Ziehl-Neelsen smear for Acid Fast Bacilli was negative.
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TB was made ( Figures 1- 3). Based on this result quadruple anti-tuberculous treatment (isoniazid 5 mg/kg, rifampicin 10 mg/kg, ethambutol 20 mg/kg, pyrazinamide 25 mg/kg) was initiated in concordance with Peruvian and international guidelines.  ,  
Contrast enhanced computed tomography showing solid focal hypodense areas of <20 mm in diameter that do not enhance with contrast (A). Diffuse thickening of parietal peritoneum with multiple hypodense nodular implants with well-defined borders; inflammatory changes in both iliac fosses; and scarce free fluid in the paracolic gutters and paravesical spaces (B).
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In addition, contrast-enhanced chest-abdomen-pelvis computed tomography (CT) and magnetic resonance imaging (MRI) showed "multiple nodular implants in spleen, gut, and peritoneal cavity; but no hepatosplenomegaly or abnormal lymph nodes enlargement" ( Figure 4).
PMC8243228_02
A: Electronic microphotography (x10) showing epiploon with chronic granulomatous inflammation, caseous necrosis (black arrow) and Langhans multinucleated giant cells (red arrow). B: Electronic microphotography (x40) showing Langhans multinucleated giant cells (red arrow); caseous necrosis (black arrow); and epithelioid histocytes (green arrows). Hematoxylin and Eosin stains. Periodic acid-Schiff and Ziehl-Neelsen stains were negative.
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Figure 5).
Contrast-enhanced computed tomography showing massive pleural effusion (red stars) with consolidation of both lungs (yellow arrows) (A and B).
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Ten days after surgery histopathology of epiploon was obtained, showing extensive caseous necrosis with granulomas and Langhans multinucleated giant cells. The patient died seven days after initiation of anti-tuberculous treatment due to refractory septic shock ( Figure 6).