scholarly journals Diagnostic challenge between Crohn's disease and intestinal tuberculosis in chronic diarrhea with ulcerated jejunal stenosis: a case report

2020 ◽  
Vol 40 (4) ◽  
pp. 346
Author(s):  
Valeria Costa-Barney ◽  
Andrés F. Delgado-Villarreal ◽  
Ana María Leguízamo ◽  
Rómulo Darío Vargas
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Chronic Diarrhea ◽  
Intestinal Tuberculosis ◽  
Immunocompetent Patient ◽  
Diagnostic Challenge ◽  
Correct Treatment ◽  
Antituberculosis Treatment ◽  
Patient At Risk

Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she mpirical antituberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

scholarly journals Recent advancements in management of gastrointestinal tuberculosis

2018 ◽  
Vol 5 (9) ◽  
pp. 3730
Author(s):  
Basim F. Khan ◽  
Ahmed M. Basha ◽  
Bandar R. Bakhurji ◽  
Bader J. Aldossari ◽  
Abdulaziz S. Alsumaihi ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Good Accuracy ◽  
Clinical Presentation ◽  
Intestinal Tuberculosis ◽  
Scoring Systems ◽  
Abdominal Tuberculosis ◽  
Diagnostic Challenge ◽  
Important Concern ◽  
Diagnostic Modalities

Abdominal tuberculosis and its protean manifestations still create a worldwide diagnostic challenge for clinicians and remain an important concern in the developing world. Crohn’s disease, which is being increasingly recognized in countries where intestinal tuberculosis is prevalent, needs to be differentiated as the two diseases resemble each other in their clinical presentation, and in their radiological, endoscopic, and histological findings. New diagnostic modalities and scoring systems have facilitated the differentiation of Crohn’s disease from intestinal tuberculosis with good accuracy. Randomized trials have shown 6 months of therapy to be equivalent to longer durations of treatment for patients with abdominal tuberculosis. 

scholarly journals Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn’s disease in patients with positive results

2020 ◽  
Vol 13 ◽  
pp. 175628482092200
Author(s):  
Yujie Zhao ◽  
Meilin Xu ◽  
Liang Chen ◽  
Zhanju Liu ◽  
Xiaomin Sun
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Interferon Gamma Release Assay ◽  
Significant Difference ◽  
History Of ◽  
Diagnosis Criteria

Aim: The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment. Methods: A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients. Results: Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml ( p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis ( p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference ( p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss ( p < 0.05). Conclusion: Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

scholarly journals P238 Enteropathy associated T-cell lymphoma as a diagnostic challenge in young patient with Crohn’s disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S284-S284
Author(s):  
A Biscanin ◽  
V Tomasic ◽  
Z Dorosulic ◽  
D Kralj ◽  
I Lerotic ◽  
...  
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
T Cell ◽  
Crohn's Disease ◽  
Coeliac Disease ◽  
Ct Scan ◽  
Laboratory Tests ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Diagnostic Challenge

Abstract Background The diagnosis of Crohn’s disease (CD) can sometimes be challenging. Enteropathy associated T cell lymphoma (EATL) is a rare aggressive lymphoma highly associated with celiac disease1. It usually affects small bowel, with signs and symptoms which may mimic CD. Methods We present a case of a 37-year-old male patient with coeliac disease, CD and (mis)diagnosed EATL in proximal jejunum. Results Patient was referred to our clinic with a constant epigastric pain, weight loss (BMI 17.5), intermittent temperatures, joint pain and diarrhoea. Laboratory tests were normal. Serology for coeliac disease was highly positive. Abdominal ultrasound showed small amount of ascites. EGD showed small shallow stomach ulcers and aphthous mucosal changes of postbulbar part of duodenum. Histology suggested coexisting CD and celiac disease. CT scan detected thickened duodenal wall and suspected duodenal stenosis and enteroscopy was performed. Approximately 80 cm from pyloric ring multiple jejunal ulcers were found. Unfortunately, biopsy was not performed. Colonoscopy showed small ulcers of terminal ileum and histology was nonspecific. Diagnosis of coexisting CD and coeliac disease was established. Therapy with PPI, systemic glucocorticoids and azatioprine was introduced. Three months later patient was in a good clinical condition, but EGD showed multiple gastric and duodenal small ulcers. Dose of azathioprine was optimized because patient refused biologics. After six months of asymptomatic period EGD showed mucosal healing. Azatioprine was continued. One year after the diagnosis of CD he was admitted again to our hospital because of intermittent fevers, severe periumbilical pain, weight loss and dehydration. Laboratory tests showed anemia (Hb 111 g/L), leucocytosis (L12.6/L) an elevated CRP (168 mg/L). CT scan detected jejunal perforation with multiple liver and spleen abscesses. He went under surgery with jejunal resection and histological findings from resected jejunum suggested EATL. In two postoperative days, the patient had progressive liver injury and suppression of bone marrow activity, and despite all supportive treatments he died. Conclusion EATL is a serious complication of coeliac disease, it rarely develops in young people and presents diagnostic challenge especially in CD patients. The aim of this report was to raise awareness of the importance of endoscopy with tissue sampling and cross sectional imaging especially in refractory coeliac disease and CD patients.

Differentiating Intestinal Tuberculosis From Crohn's Disease: A Diagnostic Challenge

2009 ◽  
Vol 104 (4) ◽  
pp. 1003-1012 ◽  
Author(s):  
Majid Abdulrahman Almadi ◽  
Subrata Ghosh ◽  
Abdulrahman Mohamed Aljebreen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Diagnostic Challenge

scholarly journals Intestinal Tuberculosis versus Crohn's Disease: Evaluating the Role of Computed Tomography Enterography in Differentiating the Two

2019 ◽  
Vol 02 (02) ◽  
pp. 116-125
Author(s):  
Saniya Muslim ◽  
Meenu Bagarhatta
Keyword(s):  
Computed Tomography ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Diagnostic Value ◽  
Diagnostic Challenge ◽  
Bowel Diseases ◽  
Computed Tomography Enterography ◽  
Inflammatory Bowel ◽  
Low Incidence

AbstractIntestinal tuberculosis (ITB) and Crohn's disease (CD) are chronic inflammatory bowel disorders that are frequently misdiagnosed due to overlapping clinical, radiologic, endoscopic, and histologic resemblance. Recent trends indicate a change in the epidemiology of inflammatory bowel diseases, with previously low-incidence areas now reporting a continuous rise in incidence. The rising incidence of CD in countries such as India where TB continues to be endemic has made the differentiation of these two disorders a diagnostic challenge. Misdiagnosis leads to delays in initiating effective therapy with increased morbidity and mortality, hence the importance of making an accurate diagnosis at the earliest possible stage. This study aimed to evaluate the diagnostic value of computed tomography enterography findings in the differential diagnosis between ITB and CD.

scholarly journals Gastrointestinal Histoplasmosis Mimicking Crohn’s Disease

2021 ◽  
Author(s):  
Esfandiar Shojaei ◽  
Joanna C Walsh ◽  
Nikhil Sangle ◽  
Brian Yan ◽  
Michael S Silverman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Antifungal Therapy ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Disseminated Histoplasmosis ◽  
Gastrointestinal Histoplasmosis ◽  
Life Threatening ◽  
Inflammatory Drugs ◽  
Tissue Specimens

Abstract Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed as biopsy-proven Crohn’s disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his GI illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn’s disease.

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