PMC6875249_01
(a) Coronal fat sat T1-weighted MR image with intravenous contrast injection showing parietal thickening of the terminal ileum (long arrow) and abdominal ascites (thick arrow). (b) CT scan showing mesenteric adenopathy (long arrow), thickening of the ileum (arrowhead), and mesenteric fluid (thick arrow).
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fig1
New work-up with total body CT scan was done showing moderate enhanced ascites associated with mesenteric fat streaking with millimetric nodules suggestive of peritoneal carcinomatosis (Figure 1).
(a) Pathology specimen revealing granulomatous tissue; (b) presence of multinucleated giant cells (thick arrow) and areas of necrosis (long arrow); (c) Ziehl-Neelsen staining showing a comma-shaped acido-alcohol resistant bacillus compatible with Koch bacillus (black circle).
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fig2
Histological result showed a necrotizing, epithelioid, and gigantocellular granulomatous reaction, with Ziehl staining showing exceptional acido-alcohol resistant bacilli compatible with Koch bacilli (Figure 2).