Abstract
Background Differentiating intestinal tuberculosis (TB) from Crohn's disease (CD) is challenging.
Even after complete workup, the underlying diagnosis can often remain unclear. Traditionally,
trial of antitubercular therapy (ATT) is resorted to in such situations, but the use
of ATT could increase stricturing complications in CD.
Methods We report findings from our cohort of patients with ileocecal ulcers. Among patients
with a diagnostic confusion between intestinal TB and CD, steroids were started in
an in-hospital setting under close observation. We report a brief series of patients
with a close overlap in terms of disease presentation, behavior, laboratory, and histopathological
findings. All the cases had skip lesions in the colon with inconclusive final diagnosis.
We attempted to differentiate between the two by a short trial of steroids for 2 weeks.
Results Of the 30 patients with ileocecal ulceration, the diagnosis remained uncertain between
intestinal TB and CD in three patients. All three patients received steroids for 2
weeks. Eventually, all were diagnosed to have TB. Administration of steroids helped
increase microbiological yield with all three having a positive microbiological diagnosis
at 2 weeks. However, one patient developed dissemination (pulmonary lesions).
Conclusion With a definitive risk of flare of TB with steroid, we encountered a positive diagnosis
with repeat colonoscopy biopsy, positive result in bronchoalveolar lavage, and in
third case positive report of cartridge-based nucleotide acid amplification test on
repeat colonoscopy biopsy. In cases where differentiation of ileocecal TB from CD
is not possible confidently, using a steroid-first approach increases the microbiological
yield with a potential risk of dissemination.
Keywords
Crohn's disease - tuberculosis - antitubercular therapy - inflammatory bowel disease
- intestinal tuberculosis
