Distinguishing between Crohn′s disease, tuberculosis, and lymphoma: Still in murky waters

Almadi, Majid A

doi:10.4103/1319-3767.136931

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Some studies had summarized the overlapping clinical presentations to make a definitive diagnosis ITB and CD, 30 – 32 but as shown in our review, any 1 or a combination of these findings do not help the clinician in making a diagnosis for an individual patient, as none of these findings have a high enough likelihood ratio to make a definitive diagnosis. 33 …”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

Wei

Wu²,

Gao³

et al. 2016

Medicine

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The differential diagnosis of Crohn's disease (CD) and intestinal tuberculosis (ITB) remains difficult as the clinical symptoms of the 2 digestive diseases are so similar. Here we report a case where a patient was initially misdiagnosed with ITB prior to the correct CD diagnosis. The 46-year-old male patient was hospitalized elsewhere for pain in the right lower abdomen and underwent an appendectomy. The pathological diagnosis was ITB and the patient was administered antituberculosis therapy for 1 year. Afterward, the patient was readmitted to the hospital for a right lower abdominal mass. A computed tomography scan revealed intestinal gas, fistula, and abdominal mass. We performed a right hemicolectomy on the patient. Postoperatively, we diagnosed the patient with CD, based on patient history and pathological examination. According to the CD active index (CDAI), the patient was at high risk and began treatment with infliximab. The patient has remained in complete remission and made a good recovery after 8-months follow-up. We compared this case with the results of a literature review on the misdiagnosis between CD and ITB (26 previously reported cases) to determine the characteristics of misdiagnosed cases. We found that distinguishing between ITB and CD is difficult because of their varied clinical presentation, nonspecific investigative tools, and profound similarities even in pathological specimens. Although a CT scan to determine the morphology of the bowel wall is a key for correct diagnosis, each case still poses challenges for diagnosis and administrating the appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

Wei

Wu²,

Gao³

et al. 2016

Medicine

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“…Features that were found to be nonspecific were the presence of acute or chronic inflammation and distortion of tissue architecture [ 21 ]. Recently, CD73 was found to be a marker for mesenchymal cells in ITB granulomas but not in CD granulomas [ 22 ]. However, cultures are still the best confirmatory test for TB, although it takes time.…”

Section: Methodsmentioning

confidence: 99%

“…Interferon-gamma release assay (IGRA) can be useful in the diagnosis of ITB. A meta-analysis found that IGRA has a mean sensitivity and specificity of 74% and 87%, respectively, for ITB [ 22 ]. Molecular techniques such as PCR have a 93% specificity in detecting ITB from biopsy samples [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract

Amarnath

Deeb

Philipose

et al. 2021

Gastroenterology Research and Practice

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A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list of causalities may prove challenging for gastroenterologists and pathologists to formulate a list of clearly defined differentials. This is true when distinguishing these etiologies based on various clinical presentations and endoscopic and histological findings. We aim to provide a comprehensive review of some of the frequent and rare infectious granulomatous diseases of the gastrointestinal tract documented in the literature to date. We provide an overview of each infectious pathology with an emphasis on epidemiology, clinical presentation, and endoscopic and histologic findings, in addition to treatment.

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“…Histopathological features suggestive of CD include noncaseating granulomas and transmural lymphoid aggregates, which are often only noticeable after examining a resected part of the bowel [ 6 ]. Differentiating CD from intestinal tuberculosis remains a diagnostic challenge and often results in a delay in the diagnosis and treatment [ 7 , 8 ]. Both CD and intestinal TB can result in fistulization into adjacent organs, commonly into other small or large bowel segments, the urinary bladder, the vagina, or even to the skin.…”

Section: Introductionmentioning

confidence: 99%