A Case of Intestinal Tuberculosis Mimicking Crohn’s Disease: A Clinical and Diagnostic Dilemma

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002699 ◽

2021 ◽

Author(s):

Sharon Weinberg ◽

Ahsan Mughal

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Immunomodulatory Drugs ◽

Medical Conditions ◽

Diagnostic Dilemma ◽

Disseminated Tuberculosis

This case highlights the importance of differentiating between Crohn’s disease and intestinal tuberculosis. The rates of misdiagnosis of Crohn’s disease and intestinal tuberculosis range from 50% to 70% because of their non-specific and clinically similar manifestations.If intestinal tuberculosis is misdiagnosed as Crohn’s disease, use of immunomodulatory drugs commonly used for Crohn’s disease can increase the risk of disseminated tuberculosis. Here we present a case highlighting the clinical similarity between these two distinct medical conditions and suggest how a similar scenario can be approached, which can help to differentiate between the two otherwise very similar conditions.

Download Full-text

Intestinal Tuberculosis Masquerading as Crohn’s Disease? A Case of Disseminated Tuberculosis after Anti-TNF Therapy for Suspected Crohn’s Disease

Case Reports in Gastrointestinal Medicine ◽

10.1155/2019/6053503 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Alexander P. Abadir ◽

James Y. Han ◽

Fady A. Youssef

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Latent Tuberculosis ◽

The United States ◽

Diagnostic Dilemma ◽

Disseminated Tuberculosis ◽

Imaging Appearance ◽

Immigrant Populations

Intestinal tuberculosis (ITB) and Crohn’s disease (CD) very closely resemble each other in symptomatology, imaging, appearance, and pathology. While ITB is rare in the United States, its prevalence is significantly higher in endemic areas, thus presenting a diagnostic dilemma in immigrant populations from high-risk countries. This patient was diagnosed with CD and treated with anti-TNF agents after indeterminate screening for latent tuberculosis. He was then admitted with septic shock and intestinal perforation due to disseminated tuberculosis. This case demonstrates the importance the consideration of ITB when a patient with risk factors for TB fails to respond to treatment for CD.

Download Full-text

Inappropriate prescription of corticosteroid therapy during inflammatory ileo-colitis revealing disseminated tuberculosis with digestive involvement: two case reports

10.22541/au.161494629.92146572/v1 ◽

2021 ◽

Author(s):

Chantelli Razafindrazoto ◽

Nitah Randramifidy ◽

Jolivet Rakotomalala ◽

Behoavy Ralaizanaka ◽

Mialitiana Rakotomaharo ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Corticosteroid Therapy ◽

Case Reports ◽

Intestinal Tuberculosis ◽

Inappropriate Prescription ◽

Disseminated Tuberculosis ◽

Therapeutic Implications

The similarity between intestinal tuberculosis and Crohn’s disease could lead us to erroneously prescribe corticosteroid therapy. Therefore, it is essential to differentiate the two pathologies because of the therapeutic implications of Crohn’s disease, which can lead to an explosion of tuberculosis symptoms.

Download Full-text

Antitubercular Therapy Given to Differentiate Crohn’s Disease From Intestinal Tuberculosis Predisposes to Stricture Formation

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa091 ◽

2020 ◽

Vol 14 (11) ◽

pp. 1611-1618 ◽

Cited By ~ 2

Author(s):

Akshita Gupta ◽

Venigalla Pratap Mouli ◽

Srikant Mohta ◽

Bhaskar Kante ◽

Mani Kalaivani ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Antitubercular Therapy ◽

Lower Probability ◽

Stricture Formation ◽

Diagnostic Dilemma ◽

Common Strategy

Abstract Background and Aim Treatment trial with antitubercular therapy [ATT] is a common strategy in tuberculosis-endemic countries in case of a diagnostic dilemma between intestinal tuberculosis and Crohn’s disease [CD]. Our aim was to determine the long-term clinical course of patients who received ATT before an eventual diagnosis of CD was made. Methods We performed retrospective comparison between CD patients who received ≥6 months of ATT vs those who did not receive ATT. Outcomes assessed were change in disease behaviour during follow-up, requirement of surgery and medication use. Results In all, 760 patients with CD were screened for the study and, after propensity matching for location and behaviour of disease, 79 patients in each group were compared. Progression from inflammatory [B1] to stricturing/fistulising [B2/B3] phenotype was increased among CD patients who received ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 41.8%, 51.9%, 6.3% at follow-up, respectively] as compared with those who did not receive ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 72.2%, 27.8%, 0% at follow-up, respectively] with an odds ratio of 11.05[3.17–38.56]. The usage of 5-aminosalocylates, steroids, immunosuppressants and anti-tumour necrosis factor was similar between both the groups. On survival analysis, CD patients who received ATT had a lower probability of remaining free of surgery [45%] than those who did not [76%] at 14 years of follow-up (hazard ratio [HR] = 3.22, 95% confidence interval [CI], 1.46–7.12, p = 0.004]. Conclusions Crohn’s disease patients diagnosed after a trial with antitubercular therapy had an unfavourable long-term disease course with higher rate of stricture formation and less chance of remaining free of surgery.

Download Full-text