INTESTINAL TUBERCULOSIS AS A DIFFERENTIAL DIAGNOSIS OF CROHN'S DISEASE – A CASE REPORT

Case Presentation A 62-year-old female presented with colicky abdominal pain and distension, but without changes in bowel habits, bleeding, weight loss, or fever. Colonoscopy revealed two oval ulcerated lesions with well-defined borders and a fibrin-covered base, with an anatomopathological diagnosis of intense chronic colitis, interstitial fibrosis, non-necrotizing granulomas, and dense eosinophilic infiltration. A biopsy slide review with microorganism investigation showed a non-caseating granuloma suggestive of intestinal tuberculosis (TB), in addition to a strongly positive PPD. The patient was referred to infectious diseases for treatment.

Discussion TB is a chronic infectious disease endemic in Brazil. Although pulmonary involvement is the most common, intestinal TB is recognized as an important clinical manifestation of the disease, and its suspicion as a differential diagnosis is crucial, especially when the clinical picture suggests other conditions. Intestinal TB can occur due to hematogenous spread of Mycobacterium tuberculosis from a primary pulmonary focus or through the ingestion of contaminated food, resulting in granuloma formation and ulceration of the intestinal mucosa. The small intestine is the most affected, with a preference for the ileum, and symptoms may include abdominal pain, nausea, vomiting, diarrhea, weight loss, fever, and rectal bleeding, often mimicking the clinical presentation of Crohn's disease (CD). Systemic and pulmonary symptoms favor a TB diagnosis, which can be confirmed by the detection of mycobacteria and the presence of caseating granulomas on biopsy. It is crucial to distinguish between the two diseases due to therapeutic and prognostic implications. The treatment of intestinal TB involves specific antimicrobial therapy with anti-tuberculosis drugs for six to nine months. In contrast, CD treatment generally includes immunosuppressive therapy, corticosteroids, and advanced therapeutic agents to control intestinal inflammation.

Conclusion Differentiating between intestinal TB and CD is challenging. Early recognition and appropriate treatment are essential to ensure favorable outcomes and prevent serious complications. Awareness among healthcare professionals, particularly in endemic areas, is critical for effective management.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025