Historical Overview and Current Approaches in Determining a Mycobacterial Etiology of Crohn’s Disease

Abstract

Although the earliest descriptions of Crohn’s disease are said to date back to the later 1600’s to early 1700’s (24), they are difficult to sort from other undefined intestinal disorders of that era. Perhaps more realistically, since Crohn’s disease and intestinal tuberculosis were confused for years and such confusion continues to this date, the earliest descriptions probably occurred sometime after the discovery of the tubercle bacillus in 1882 (25). Nevertheless, sometime after that period, an intestinal disease was recognized that was similar to intestinal tuberculosis, but acid fast bacilli could not be visualized in tissues or isolated in culture and the characteristic caseous nodules of tuberculosis were absent. By 1913, cases of intestinal tuberculosis which did not fit the classical pattern were well recognized, but nevertheless, were classified among the tuberculous lesions and the disease was known as hyperplastic tuberculosis (44). By the 1920’s, these cases of intestinal tuberculosis which did not contain caseous necrosis or acid fast bacilli were reclassified as nonspecific granulomata (30,44) in an attempt to recognize these cases as distinct from the classical or hypertrophic forms of intestinal tuberculosis. Each description, however, discussed the remarkable resemblance of these cases to intestinal tuberculosis — the only difference being the absence of the pathognomonic lesions of tuberculosis, caseous necrosis and acid fast bacilli.