P0634 ABDOMINAL TUBERCULOSIS WITHOUT PULMONARY INVOLVEMENT: DIFFERENTIAL DIAGNOSTIC WITH CROHN???S DISEASE

Abstract

Introduction: Tuberculosis is a relatively common disease in developing countries. Abdominal tuberculosis(AT)is a rare location of this infectious disease with diagnostic difficulties until today. In most, disease is confined to the terminal ileum and cecum. We report one case of colonic commitment, similar to Crohn’s disease. Methods: Restrospective study of clinical records Results: A ten-year-old boy, with diary abdominal pain, low-grade fever, weight loss and mucopurulent chronic diarrhea for the last 4 months was admitted at the gastropediatric unit of Hospital Municipal Jesus. The severity of symptoms majored with bloody diarrhea and severe pain. No previous pathological history was found. BCG scar was present, PPD reaction and anti- HIV were negative, normal thorax scan, ESR = 90 mm, hemoglobin= 9,7g/dl, hematocrite= 30,5% abdominal ultrasound (US) with evidences of thickening of mesentery and colonic wall (distal transverse colon and proximal left colon), narrowing of intestinal lumen, similar to inflammatory bowel disease. Sulfasalazine was the initial therapy on Day(D) 2 of evolution, associated to metilprednisolone on D10. Fever, pain and diarrhea decreased after D11. On D28, abdominal US demonstrated reduction of mural thickness of the colon and colonoscopy with thickening of splenic flexure, nodularity of mucosal surface with some ulceration similar to Crohn’s disease. Metilprednisolone was switched to prednisona. On D43, barium enema had evidencieted luminal narrowing of splenic flexure. Clinical improvement was achieved but on D44, the colonic biopsy was compatible with granulomatous inflammatory process with innumerous BAAR (Ziel-Nielsen positive). The corticotherapy was then progressive suspended and The RIP schema was began (usual doses). He went home on D56 without symptoms. After 3 months of RIP treatment, an intestinal suboclusion leads to colectomy of distal transverse and proximal left colon with evidences of fistulas. Tuberculosis was confirmed byhistopathological study of the specimen. Conclusion: The therapy was suspended with success after 9 months. The patient remains well until now. The diagnosis of AT was misdiagnosed because the absence of laboratorial evidence of the infection and clinical improvement after Crohn’s disease therapy.