An 18-year-old long-term Norwegian resident of Somali origin was submitted to hospital with bloody diarrhoea, fever, weight loss and abdominal pain. On initial colonoscopy, colitis with segmental appearance was seen. Apart from a single polymerase chain reaction (PCR) from gastric aspirate staining, PCR and culture for acid-fast bacilli revealed negative results from the multiple samples taken including sputum, gastric fluid, stool, urine and intestinal mucosa. On physical examination and CT scan, there was no evidence of ascites, lymph node enlargement or pathologic pulmonary findings. Although the diagnosis was uncertain, tuberculostatic therapy was initiated. As the conformational testing of the PCR and the microbiological work-up remained negative and the patient's condition did not improve, tuberculostatic treatment was stopped and Crohn's disease was stated as the most likely diagnosis. Although the patient improved clinically under therapy with prednisolone, newly appearing fistulas deriving from the ascending colon were noted on follow-up. Thus tuberculostatic treatment was restarted. However, signs of an acute abdomen appeared and laparotomy was performed, thereby revealing a peritoneal spread of nodules. Resection of the ileum and ascending colon was performed. Diagnosis of intestinal tuberculosis with peritoneal spread was made by histology from resected bowel specimens showing caseating granulomas and a positive PCR result. The patient's condition improved after resection of the highly inflamed bowel segments and tuberculostatic therapy. Our case report shows the difficulty of proving intestinal tuberculosis by microbiological testing, macroscopic features on colonoscopy, histology, imaging such as CT scan and by empirical therapy. Therefore, in cases of colonic inflammation, where intestinal tuberculosis is an important differential diagnosis, a more aggressive diagnostic approach such as explorative laparoscopy should be considered.
"To find a solution for making the differential diagnosis, clinical, radiological, colonoscopic and histopathological methods or parameters have been studied, but no satisfactory method has yet been proposed. Under these circumstances, as a new biomarker, the PCR method for detecting tuberculosis was introduced, and it has drawn much attention from clinicians and pathologists since it was applied in the clinical setting8-11). Contrary to diagnosing pulmonary tuberculosis, it has shown a different result for the diagnosis of IT; the specificity is very high (95~100%) but the sensitivity is very low (9.8~64.1%). Therefore, it is only recommended as an additional diagnostic tool. "
[Show abstract][Hide abstract] ABSTRACT: Since the pathologic findings of Crohn's disease (CD) and intestinal tuberculosis (IT) overlap to a large degree, the development of other biomarkers will be of great help for making the differential diagnosis of these 2 diseases. The aim of the present study is to examine the clinical efficacy of using the tissue angiotensin converting enzyme (ACE) assay in making the differential diagnosis between CD and IT.
Tissue specimens were obtained from 36 patients who were diagnosed with CD or IT by the colonoscopic biopsy, as well as by the clinical findings. The expression of tissue ACE was detected by immunohistochemical staining. The optimal cut-off value of the immunoreactive scoring (IRS) system we used to differentiate CD from IT was determined by analysis of the ROC curve and AUROC.
Granuloma was present in 15 of 19 patients with CD (78.9%) and in 15 of 17 patients with IT (88.2%). ACE was present in the cytoplasm of the epithelioid cells in the granulomas from 13 of 15 patients with CD and in 14 of 15 patients with IT. The IRS scores of ACE were greater in the patients with CD than that of the patients with IT (8.07 +/- 4.38 vs. 4.13 +/- 2.47, respectively, p = 0.006). In differentiating CD from IT, the AUROC curve for the IRS of ACE was 0.767 with a sensitivity of 66.7%, a specificity of 93.3% and the cut-off point was 7.5.
The results of our study suggest that the assessment of the tissue ACE expression can be helpful for making the differential diagnosis between CD and IT.
The Korean Journal of Internal Medicine 04/2007; 22(1):1-7. DOI:10.3904/kjim.2007.22.1.1 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Two patients previously diagnosed as Crohn's disease were admitted to our hospital because of repeated diarrhea for one year. A definite diagnosis of intestinal tuberculosis was made on the basis of pathological examination, ch e st X - r a y a n d sp u t u m sme a r t e st . Th i s observation suggests that a prior consideration of management of tuberculosis is a relatively safe principle when it is difficult to make a differential diagnosis between intestinal tuberculosis and Crohn's disease.
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