IDDF2018-ABS-0043 Ileocaecal crohn’s disease misdiagnosed as tuberculosis in young lady- a case report

Abstract

Background Large number of patients with Crohn’s disease (CD) are initially misclassified as intestinal tuberculosis (TB) in TB endemic areas, and some patients develop activation of latent TB during treatment for CD with biologics and immunosuppressants, we present a case of young lady who was diagnosed as CD, whose initial diagnostic workup suggested TB. Methods A 23 year young female presented in 2013 with complaints of abdominal pain of one year duration and weight loss of 5 kg and anorexia since one month. She was a known case of β thalassemia minor. General and abdominal examination were unremarkable. Investigations revealed microcytic hypochromic anaemia, ESR- 14, normal albumin and chest roentgenogram. Colonoscopy was suggestive of ileocaecal valve deformity with ulcers and terminal ileal ulcers and normal colonic mucosa. Histopathological examination of ileal biopsy was reported as severe typhilitis, and mycobacterial DNA PCR of ileal biopsy had detected M. Tuberculosis complex. She was started on four drugs first line antitubercular therapy in 2013 for ileocaecal tuberculosis. At 4 months follow up, abdominal pain was present but with reduced frequency and she had gained 3 kg weight. She again came for follow up in 2014 after taking antitubercular therapy for 9 months with complaints of abdominal pain and significant weight loss. She had undergone colonoscopy and laparoscopy at our centre for the diagnostic dilemma of tuberculosis/Crohn’s disease. Results Colonoscopy had revealed oedematous ileocaecal valve with terminal ileum nodularity and ulceration. Laparoscopy had revealed creeping fat and a diseased terminal ileal segment with mesenteric lymphadenopathy without evidence of omental thickening or peritoneal nodularity. Histopathology of terminal ileum had revealed moderate ileitis with non-caseating epitheloid cell granuloma without giant cell. She was started on immunosuppressive therapy for Crohn’s disease and responded to treatment. She was in remission after 3 years of follow up. Conclusions Distinguishing between TB and CD is difficult because of varied clinical features, similar pathological, imaging and endoscopic appearances. This case represents CD misdiagnosed as TB in a young lady as tissue TB PCR was false positive and it has low sensitivity than previously described.