Abdominal tuberculosis mimicking Crohn’s disease’s exacerbation: A clinical, diagnostic and surgical dilemma. A case report

Abstract

HighlightsTuberculosis is a health public problem, which has increased over the last 20 years.The diagnosis of extrapulmonary tuberculosis can be challenging, and in particular clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies.Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage, anyway diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons.Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

“…The laboratory features mainly included anemia, 1 , 2 , 9 – 12 , 16 , 18 , 19 raised erythrocyte sedimentation rate (ESR), 4 , 9 , 12 , 17 – 19 and raised C-reactive protein (CRP). 4 , 14 , 18 , 19 Other laboratory features were normal or not described. The clinical and laboratory features observed in the patients are summarized in Table 1 .…”

“…In these cases, the initial symptoms include abdominal pain, 1 – 17 diarrhea, 1 , 2 , 4 , 7 – 9 , 11 , 12 , 14 , 17 – 20 weight loss, 1 , 4 , 7 , 9 – 11 , 13 – 19 fever, 2 , 3 , 6 – 9 , 11 , 13 , 16 , 17 , 19 hematochezia, 5 , 18 , 21 , 22 anorexia, 1 , 6 , 10 , 14 , 15 , 17 vomiting, 1 , 7 , 10 , 15 , 17 intestinal obstruction, 3 , 6 and dyspnea. 2 The abdominal physical examinations were normal or not described in most cases.…”

“…The CT imaging morphology findings can be summarized as follows: segmental and irregular thickening of the involved bowel, 1 , 4 , 6 , 8 , 9 , 11 , 12 , 14 , 16 , 22 , 23 enlarged lymph nodes, 4 , 8 , 12 , 14 , 23 fistula, 18 and ascites. 14 However, none of these findings could be used to distinguish CD from ITB. Interestingly, almost all ITB patients were associated with normal chest radiographs.…”

“…Interestingly, almost all ITB patients were associated with normal chest radiographs. Among the colonoscopy features, pseudopolyps 1 , 2 , 5 , 9 , 11 , 19 and ulcerative lesions 1 , 2 , 4 – 6 , 9 , 10 , 12 , 14 , 15 , 17 – 20 , 23 were the most common reasons for misdiagnosis. Other reasons included exudates, 2 , 4 nodularity, 2 , 16 , 17 cobblestone mucosa, 4 and skip areas of inflammation and ulceration.…”

“…Twelve patients (44.4%) received CD-related drugs as the initial treatment, 9 patients were given corticosteroids 1 , 2 , 7 , 10 , 14 , 15 , 17 – 19 , 23 , 24 (methylprednisolone and prednisone), 1 patient was given azathioprine, 1 , 14 7 patients were discharged with 5-aminosalicylic acid (5-ASA), 2 , 9 – 12 , 14 , 15 , 18 , 24 1 patient was given budesonide. 11 After failure of corticosteroid treatment, 6 patients received surgical treatment.…”