Intestinal tuberculosis and Crohn's disease: challenging differential diagnosis

Abstract

Along with epidemiological changes in tuberculosis (TB) and an increased incidence of Crohn's disease (CD), the differential diagnosis of intestinal TB (ITB) and CD is of vital importance and has become a clinical challenge because treatment based on misdiagnosis may lead to fatal outcomes. In this study, we reviewed the similarities and differences in clinical, endoscopic, radiological and histological features of these two diseases. Concomitant pulmonary TB, ascites, night sweats, involvement of fewer than four segments of the bowel, patulous ileocecal valve, transverse ulcers, scars or pseudopolyps strongly indicate ITB. Bloody stools, perianal signs, chronic diarrhea, extraintestinal manifestations, anorectal lesions, longitudinal ulcers and a cobblestone appearance are all suggestive of CD. Significant differences in the size, number, location and patterns of granulomas in ITB and CD with regard to their histopathologic features have been noted. Immune stain of cell surface markers is also helpful. Interferon-γ release assay and polymerase chain reaction analysis have achieved satisfactory sensitivity and specificity in the diagnosis of ITB. Computed tomography enterographic findings of segmental small bowel or left colon involvement, mural stratification, the comb sign and fibrofatty proliferation are significantly more common in CD, whereas mesenteric lymph node changes (calcification or central necrosis) and focal ileocecal lesions are more frequently seen in ITB. A diagnosis should be carefully established before the initiation of the therapy. In suspicious cases, short-term empirical anti-TB therapy is quite efficient to further confirm the diagnosis.

Temporal trends in the misdiagnosis rates between Crohn’s disease and intestinal tuberculosis

“…In most cases, ITB can be cured with proper anti-TB drugs with a favorable outcome, while CD is a chronic disease needing lifelong management. Moreover, the misdiagnosis of ITB as CD can lead to worse outcomes, because immunosuppressive drugs, such as corticosteroids, thiopurines, and anti-tumor necrosis factor agents can aggravate ITB[ 14 ]. Conversely, the misdiagnosis of CD as ITB can render the CD patients exposed to the potential toxicity of anti-TB drugs and delay the proper treatment of CD.…”

Application value of tissue tuberculosis antigen combined with Xpert MTB/RIF detection in differential diagnosis of intestinal tuberculosis and Crohn’s disease

“…The sensitivity of combined detection was improved compared to the single detection sensitivity, but the specificity declined. Discussion differentiate [18] . Some studies have proposed certain criteria for identifying CD and ITB, but these criteria have been shown to have great limitations [19][20][21] .…”

The Challenge of Inflammatory Bowel Disease Diagnosis in Asia

“…In some countries where infections are endemic, health care providers might simply assume that abdominal symptoms are due to infections or TB without performing endoscopy. It was reported that the misdiagnosis rates between CD and ITB ranged from 50 to 70% [26] .…”