Ziekte van Crohn versus abdominale tuberculose: ‘when the bowels are not what they seem’

Abstract

Abdominal tuberculosis mimicking Crohn’s disease: be aware of false-negative testing when stakes are high Differentiating between abdominal tuberculosis (TB) and Crohn’s disease (CD) can be very challenging. Both are chronic granulomatous diseases involving the gastro-intestinal tract, most typically the ileocecal region, with overlapping clinical, radiological, endoscopic and histological features. A correct differentiation is, however, crucial as the repercussions of a misdiagnosis can be serious. If CD is misdiagnosed as abdominal TB, unnecessary anti-tuberculous therapy poses a risk of toxicity and the appropriate CD treatment is delayed. In case of the reverse misdiagnosis, treatment with steroids or other immunosuppressants can result in disastrous dissemination of TB. The incidence rates of TB are generally low in Western Europe. Still, abdominal TB should be considered in the differential diagnosis of abdominal complaints, especially in patients with risk factors such as previous stays in endemic regions and HIV positive or immunocompromised patients. A high index of suspicion is important as no single test can reliably differentiate abdominal TB from CD in all patients. Concurrent immunosuppression may further reduce the sensitivity of the diagnostic tests. In this article, the case of a young man with severe ileocolitis is presented. He was diagnosed with CD and started on corticosteroids and later anti-TNF-alpha agents, only to develop an acute abdomen based on a disseminated TB infection. Retrospectively, abdominal TB was most probably the primary diagnosis, mimicking CD. This case illustrates the diagnostic challenges and limitations of the available diagnostic tests, as well as the clinical importance to exclude abdominal TB before diagnosing CD and starting immunosuppressive therapy.