asymptomatic tuberculosis-induced ileal perforation in an hiv- infected individual; a case report

the co-existence of acquired immune  deficiency syndrome (aids) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. the gastrointestinal tract is a common site for localization of opportunistic  microorganisms  in aids. however, surgical abdominal  emergencies such as intestinal perforation resulted from tuberculosis are uncommon  in these patients. the asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. we represent an hiv and hcv co-infected man with miliary tuberculosis and an incidentally detected free air under  diaphragm in the chest x-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. it seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in hiv-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation.