Abdominal tuberculosis misdiagnosed as Crohn's disease

Introduction: Tuberculosis may mimic many other diseases. Intestinal tuberculosis is part of the differential diagnosis of inflammatory bowel disease.

Case report: We present a case of a 59 years old native Hungarian female, who was referred to our outpatient clinic with bloody stool. On initial examination she was found to have histological proven Crohn's disease with ulcerations in the distal part of the ileum, the cecum and the ascending colon. Because her condition worsened despite the administration of a mesalazine preparation, she was admitted to our hospital and treated with parenteral steroid. An ultrasonographic examination suggested that there was a mass in the region of the pancreas, which led us think she had two illnesses at the same time, a probably uncurable pancreatic cancer as well as Crohn's disease. Despite the above treatment she died shortly afterwards.

Results: At autopsy in addition to the numerous ulcers in the ileocecal region she was found to have caseating granulomas in the mesenteric lymph nodes and those adjacent to the pancreas. The pancreas itself was normal. Upon reexamination the previous colonoscopic samples with acid fast stain Mycobacteria were identified.

Conclusion: Even though tuberculosis of the alimentary tract is a rare disease in developed countries, it should be taken in consideration of differential diagnosis of inflammatory bowel disease.