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Case Reports
. 2016 Jan;95(1):e2436.
doi: 10.1097/MD.0000000000002436.

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis: Case Report and Literature Review

Jiang-Peng Wei  1 , Xiao-Yan Wu, Sen-Yang Gao, Qiu-Yu Chen, Tong Liu, Gang Liu
Affiliations
Case Reports

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis: Case Report and Literature Review

Jiang-Peng Wei et al. Medicine (Baltimore). 2016 Jan.

Abstract

The differential diagnosis of Crohn's disease (CD) and intestinal tuberculosis (ITB) remains difficult as the clinical symptoms of the 2 digestive diseases are so similar. Here we report a case where a patient was initially misdiagnosed with ITB prior to the correct CD diagnosis. The 46-year-old male patient was hospitalized elsewhere for pain in the right lower abdomen and underwent an appendectomy. The pathological diagnosis was ITB and the patient was administered antituberculosis therapy for 1 year. Afterward, the patient was readmitted to the hospital for a right lower abdominal mass. A computed tomography scan revealed intestinal gas, fistula, and abdominal mass. We performed a right hemicolectomy on the patient. Postoperatively, we diagnosed the patient with CD, based on patient history and pathological examination. According to the CD active index (CDAI), the patient was at high risk and began treatment with infliximab. The patient has remained in complete remission and made a good recovery after 8-months follow-up. We compared this case with the results of a literature review on the misdiagnosis between CD and ITB (26 previously reported cases) to determine the characteristics of misdiagnosed cases. We found that distinguishing between ITB and CD is difficult because of their varied clinical presentation, nonspecific investigative tools, and profound similarities even in pathological specimens. Although a CT scan to determine the morphology of the bowel wall is a key for correct diagnosis, each case still poses challenges for diagnosis and administrating the appropriate treatment.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Computed tomography of the right lower abdomen showing the wall thickness of the ascending colon with the gas shadow in swelling soft tissue of the right lower abdominal wall.
FIGURE 2
FIGURE 2
Macroscopic histopathology showing that both the ascending colon and anastomosis wall are thickened and the lumen is narrowed.
FIGURE 3
FIGURE 3
The pathology of the ascending colon biopsies showing granuloma.
See this image and copyright information in PMC

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