Intestinal tuberculosis – a case series mimicking as inflammatory bowel disease

Aims: Intestinal tuberculosis is a great mimic of other conditions, and can be easily misdiagnosed. We report a case series presenting to an IBD clinic in a tertiary hospital in Ireland.

Cases: Case 1 is an Indian man with melaena and night sweats. Colonoscopy showed stricture and ulcerations in the ascending colon. Histology showed inflammation and granulomas. Mantoux test was strongly positive. Empiric treatment with anti-tuberculous medications dramatically improved symptoms.

Case 2 is a woman with abdominal pains and bloody diarrhoea. She developed abscesses and a colo-cutaneous fistula, through which she had a haemorrhage which needed emergency colectomy. Tissue cultures grew Mycobacterium Tuberculosis.

Case 3 is an Indian man presenting with weight loss and diarrhoea. CT scan showed an abnormal small bowel with a thickened mesentery. Laparotomy and histology revealed caseating granulomas on the omentum. Cultures grew M.Tuberculosis.

Case 4 is a girl who presented with abdominal pains. Imaging showed an abnormal terminal ileum, and ascending colon. There were upper zone calcifications on her CXR, and her Mantoux test was positive. Anti-tuberculosis treatment improved her symptoms, with resolution of abnormalities on CXR.

Conclusions: Intestinal tuberculosis easily presents as IBD, as evidenced by all 4 cases identified in an IBD clinic. Awareness of this important differential is crucial, with immigration on the increase. Furthermore, the use of anti-TNF therapy, immunosuppressants and steroids could have a devastating effect if used in this scenario.