Gastrointestinal Tuberculosis mimicking Crohn’s Disease. Case report and review of the literature

Abstract

Although in recent years there has been a rise in Gastrointestinal
Tuberculosis (GITB) incidence among immigrants
and HIV patients, both in Europe and United States,
the diagnosis is usually overlooked due to lack of experience
and the similarity of the disease with other entities
such as Crohns disease, ileocecal lymphoma and peri-appendiceal
abscess. The peritoneum and the ileocecal region
are the most likely sites of infection. The transmission in
the majority of cases is by hematogenous spread or through
the swallowing of infected sputum from patients with primary
pulmonary tuberculosis. Pulmonary tuberculosis is
evident in less than half of patients.
A case of a 26 year old woman who was admitted to this
department for an abdominal abscess and prolonged fever
is reported. Physical examination, laboratory studies, and
imaging findings were suggestive of Crohns disease. However
treatment with steroids and azathioprine led to clinical
deterioration and the patient underwent ileocolic resection.
Abscess fluid culture and polymerase chain reaction
(PCR) assay of histological specimens demonstrated the
presence of mycobacterium tuberculosis and established
the diagnosis of GITB. The patient is now well under standard
anti-Tb therapy.
Key words: Gastrointestinal tuberculosis, abdominal abscess,
prolonged fever.