Abstract
BackgroundCrohn disease has low prevalence in Sri Lanka while compared to the West, while intestinal tuberculosis is common in the region. Since clinical, endoscopic and investigation features of Crohn disease overlap with intestinal tuberculosis, differentiating these two conditions becomes a dilemma for the clinician in the intestinal tuberculosis endemic setting.Case summaryAn 18-year old Sri Lankan Muslim female presented with chronic abdominal pain and weight loss. Colonoscopy revealed an ulcerated ileocaecal valve and a terminal ileal stricture. Biopsy confirmed Crohn disease with no supportive features to suggest intestinal tuberculosis. Despite treatment with adequate immunosuppression she failed to improve and underwent a limited right hemicolectomy and terminal ileal resection. Histology confirmed intestinal tuberculosis and she made full recover with 6 months of anti-tuberculosis treatment.ConclusionThis case illustrates the importance of reviewing the diagnosis to include intestinal tuberculosis in an endemic setting, when already diagnosed Crohn disease is treatment refractory.
Highlights
Crohn disease has low prevalence in Sri Lanka while compared to the West, while intestinal tuberculosis is common in the region
This case illustrates the importance of reviewing the diagnosis to include intestinal tuberculosis in an endemic setting, when already diagnosed Crohn disease is treatment refractory
The prevalence of Crohn disease (CD) is low in Sri Lanka compared to the West
Summary
The prevalence of Crohn disease (CD) is low in Sri Lanka compared to the West. Crohn disease is increasingly diagnosed in recent years [1]. Case presentation An 18 year old Sri Lankan Muslim female, presented with a 9 month history of colicky right iliac fossa pain and a 5 kg weight loss. Colonoscopy revealed an ulcerated ileocaecal valve and a terminal ileal stricture, while the colon itself was macroscopically normal. Biopsy of these lesions was reported as suggestive of CD. Mantoux test and Quantiferon gold test for TB were negative and chest X-ray was normal She was started on treatment for CD with a short course of oral steroids followed by azathioprine. She completed 6 months of ATT and made a full recovery
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