Zusammenfassung:
Die Krankengeschichten zweier aus Asien stammender Immigrantinnen
mit Darmtuberkulose verdeutlicht die Schwierigkeiten der Diagnosefindung.
Insbesondere der Morbus Crohn lässt sich wegen der Ähnlichkeiten des
klinischen Verlaufes sowie des makroskopischen und mikroskopischen Bildes kaum
von der Darmtuberkulose abgrenzen. Allerdings kann die subtile Beobachtung
morphologischer Veränderungen am Darm anamnestische Hinweise auf eine
Intestinaltuberkulose erhärten. Die Diagnosesicherung erfolgt durch
Erregernachweis. Da dieser Nachweis in Einzelfällen schwierig zu
führen ist, kann eine probatorische Therapie bei dringendem Verdacht
diskutiert werden.
Intestinal tuberculosis: Easier overlooked than diagnosed
The medical history of two Asian immigrants suffering from
intestinal tuberculosis demonstrates the difficulties in finding the correct
diagnosis. Intestinal tuberculosis resembles Crohn’s disease with regard
to clinical symptoms, macroscopic and microscopic intestinal findings.
Sonographic, radiologic, endoscopic, and histological examinations facilitate
distinguishing both entities. Diagnosis of intestinal tuberculosis is made by
identification of the causative microorganism in tissue specimens. As this may
be difficult and time-consuming, a therapeutic trial with anti-tuberculous
agents may be warranted.
Schlüsselwörter
Intestinale
Tuberkulose - Morbus Crohn - Granulome
Key words
Intestinal
Tuberculosis - Crohn’s Disease - Granuloma
Literatur
1 Lewis S, Field S. Intestinal and peritoneal tuberculosis. Rom WN, Garay
SM Little, Brown and Company Boston, New York,
Toronto,
London; Tuberculosis 1995: 585-597
2
Palmer K R, Patil D H, Basran G S, Riordan J F, Silk D BA.
Abdominal tuberculosis in urban Britain - a common
disease.
Gut.
1985;
26
1296-1305
3
Netto E M, Dye C, Raviglione M C.
Progress in global tuberculosis control 1995-1996, with
emphasis on 22 high-incidence countries. Global monitoring and surveillance
project.
Int J Tuberc Lung
Dis.
1999;
3
310-320
4
Nelson K R, Bui H, Samet J H.
Screening in special populations: A „case
study” of recent Vietnamese immigrants.
Am J
Med.
1997;
102
435-440
5
Keane V P, O’Rourke T F, Bollini P, Pampallona S, Siem H.
Prevalence of tuberculosis in Vietnamese migrants: The
experience of the orderly departure program.
Southeast Asian J Trop
Med Public
Health.
1995;
26
642-647
6
Horvath K D, Whelan R L.
Intestinal tuberculosis: return of an old
disease.
Am J
Gastroenterol.
1998;
93
692-696
7
Schluger N W, Condos R, Lewis S, Rom W N.
Amplification of DNA of Mycobacterium tuberculosis from
peripheral blood of patients with pulmonary
tuberculosis.
Lancet.
1994;
344
232-233
8
MacIntyre C R, Plant A J.
Longitudinal incidence of tuberculosis in South-East-Asian
refugees after re-settlement.
Int J Tuberc Lung
Dis.
1999;
3
287-293
9
Marshall J B.
Tuberculosis of the gastrointestinal tract and
peritoneum.
Am J
Gastroenterol.
1993;
88
989-999
10
Gebert A, Göke M, Rothkötter H J, Dietrich C F.
Mechanismen der Antigenaufnahme im Dünn- und Dickdarm:
die Rolle der M-Zellen für die Initiierung von Immunantworten.
Z
Gastroenterol.
2000;
38
855-872
11
Sneller M C, Strober W.
M cells and host defense.
J Infect
Dis.
1986;
154
737-741
12 Hamer D H, Gorbach S L. Infectious diarrhea and bacterial food
poisoning. Feldman M, Scharschmidt BF, Sleisenger
MH Sleisenger & Fordtran’s gastrointestinal and liver
disease: Pathophysiology/diagnosis/management Philadelphia,
London, Toronto, Montreal, Sydney, Tokyo; W. B. Saunders
Company 1998 6th
ed: 1622-1624
13
Arnold C, Moradpour D, Blum H E.
Tuberculous colitis mimicking Crohn’s
disease.
Am J
Gastroenterol.
1998;
93
2294-2296
14
Furtmüller F, Haidinger D.
Ileozäkaltuberkulose: ein seltenes
Krankheitsbild.
Z
Gastroenterol.
1991;
29
609-612
15
Dietrich C F, Brunner V, Lembcke B.
Intestinale Sonographie bei seltenen Dünn- und
Dickdarmerkrankungen.
Z
Gastroenterol.
1998;
36
955-970
16
Bhargava D K, Kushwaha A K, Dasarathy S, Shriniwas, Chopra P.
Endoscopic diagnosis of segmental colonic
tuberculosis.
Gastrointest
Endosc.
1992;
38
571-574
17
Shah S, Thomas V, Mathan M. et al .
Colonoscopic study of 50 patients with colonic
tuberculosis.
Gut.
1992;
33
347-351
18
Pulimood A B, Ramakrishna B S, Kurian G. et al .
Endoscopic mucosal biopsies are useful in distinguishing
granulomatous colitis due to Crohn’s disease from
tuberculosis.
Gut.
1999;
45
537-541
19
Bhansali S K.
Abdominal tuberculosis. Experiences with 300
cases.
Am J
Gastroenterol.
1977;
67
324-337
20
Bukharie H.
Paradoxical response to anti-tuberculous drugs: Resolution
with corticosteroid therapy.
Scand J Infect
Dis.
2000;
32
96-97
21
Bilaceroglu S, Perim K, Buyuksirin M, Celikten E.
Prednisolone: A beneficial and safe adjunct to
antituberculosis treatment? A randomized controlled trial.
Int J
Tuberc Lung
Dis.
1999;
3
47-54
22
Alzeer A H, Fitzgerald J M.
Corticosteroids and tuberculosis: Risks and use as adjunct
therapy.
Tuber Lung
Dis.
1993;
74
6-11
23
Law N M, Lim C C, Chong R, Ng H S.
Crohn’s disease in the Singapore Chinese
population.
J Clin
Gastroenterol.
1998;
26
27-29
24
Pai C G, Khandige G K.
Is Crohn’s disease rare in India?.
Indian J
Gastroenterol.
2000;
19
17-20
25
Sung J J, Hsu R K, Chan F K. et al .
Crohn’s disease in the Chinesepopulation. An
experience from Hong Kong.
Dis Colon
Rectum.
1994;
37
1307-1309
Anschrift für die Verfasser
Dr. med. Michael N. Göke
Abteilung Gastroenterologie und Hepatologie Medizinische
Hochschule Hannover
Carl-Neuberg-Straße 1
30625 Hannover
Email: goeke.michael@mh-hannover.de