Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

Wei, Jiangpeng; Wu, Xia; Gao, Sen-Yang; Chen, Qiuyu; Liu, Tong; Liu, Gang

doi:10.1097/md.0000000000002436

Cited by 21 publications

(17 citation statements)

References 38 publications

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“…At the diagnosis of IBD, a combination of the acid-fast stain, culture and NAAT of intestinal tissue would have prevented a misdiagnosis in several cases in this study and thus would have improved the prognosis of the patients. In the pathological diagnosis, necrotizing granulomas and large granulomas were typical findings of ITB (12,21) as detected in three acid-fast bacilli negative cases.…”

Section: Discussionmentioning

confidence: 68%

“…Because there are only a few case reports concerning the misdiagnosis of ITB as IBD in Japan (10) and a few such studies in the world (11,12), little is known about clinical features, prevalence, and prognosis of those cases. The aim of this study was to elucidate the diagnostic delay and prognosis of ITB cases initially misdiagnosed as IBD.…”

Section: Introductionmentioning

confidence: 99%

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Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

et al. 2019

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Objective Intestinal tuberculosis (ITB) and inflammatory bowel disease (IBD) frequently present with similar clinical, endoscopic and pathological features, therefore it is difficult to differentiate between them. The aim of this study was to elucidate the diagnostic delay and prognosis of ITB cases, initially misdiagnosed as IBD. Methods ITB cases were selected from the hospitalized patient list between April 2004 and March 2017 in a tuberculosis center in Japan. We retrospectively evaluated the initial diagnosis, clinical characteristics, endoscopic and pathological findings, bacterial examinations, treatment and prognosis. Results Among 66 ITB patients, ten patients were initially misdiagnosed as IBD. Seven patients were male and the median age was 60.5 years (23-74 years). After the diagnosis of IBD, all the patients were treated with mesalazine, in addition to corticosteroids in two patients and sequential azathioprine and infliximab in one. The median duration of diagnostic delay was 5.5 months (range 0.5-17 months). Eight patients had active pulmonary tuberculosis at the diagnosis of ITB. Acid-fast bacilli were confirmed in four of seven patients by reevaluation of the pathological specimens at the IBD diagnosis. Two patients needed intestinal resection and one with erroneous corticosteroid use for IBD died due to respiratory failure in spite of receiving appropriate treatment for tuberculosis. Conclusion ITB patients were frequently misdiagnosed and treated as IBD, thus resulting in a poor clinical outcome even after finally making a correct diagnosis and administering appropriate treatment. On diagnosis of IBD and/or treatment failure, chest radiograph and acid-fast bacilli of the pathological specimens should be carefully evaluated in order to rule out tuberculosis.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

et al. 2019

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“…The main cause of diagnosis error is the absence on caseous necrosis and the lack of sensibility of Ziehl stain on histologic analyses. 2 TB in a context of anti-TNF-a therapy is difficult to diagnose with few symptoms, extrapulmonary presentations, and a potentially severity with a rapid evolution. This observation suggests a repeated screening for TB during the follow-up of these patients, all the more if other risk factors are associated, namely, concomitant immunosuppressant use, a history of latent or active TB, birth or travel in endemic region of TB, and/or exposure to a person with TB.…”

Section: Answer To: Image 2 (Page 1239): Tuberculosis Cutis Orificialismentioning

confidence: 99%

A Surprising Granulomatous Cheilitis

et al. 2018

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Question: A 17-year-old Algerian girl who had lived in France for 2 years was referred to our dermatologic unit for a painful infiltrated crusty cheilitis. She was under anti-tumor necrosis factor-a (anti-TNF-a) therapy for active Crohn disease (CD). CD was diagnosed in 2011 on rectal bleeding, weight loss and ileal ulcerations at colonoscopy. She was previously treated with 5-ASA and azathioprine without efficacy. Adalimumab was introduced in May 2015 after a pretherapeutic evaluation that included negative interferon-gamma release assay (IGRA). Dose of adalimumab was majored to 40 mg per week in December 2015 because her CD remained active. Four months later, labial lesions appeared, with edema and vesicles, and progressed to a painful infiltrated and crusty cheilitis. Antibiotics and valaciclovir treatments were unsuccessful. Oral examination revealed a unilateral cobblestone aspect with pustules on the lip mucosa without affecting the rest of oral cavity (Figure A, B). A centimetric right cervical adenopathy was noticed. She did not have any other complaints, and the rest of physical findings were normal. Laboratory results from blood chemistry, complete blood cell count, liver, and kidney analysis were within reference range. C-reactive protein was elevated (117 mg/L). Infectious workup (human immunodeficiency virus and syphilitic serology, leishmania, and herpes polymerase chain reaction) was negative. Standard chest radiography was normal. Magnetic resonance enterography revealed an asymptomatic terminal ileitis with an enhancement of the submucosa. Labial biopsies showed an epithelioid and giant cell granuloma without caseous necrosis (Figure C); Ziehl-Neelsen, Grocott and periodic acid-Schiff stains were negative for acid-fast bacilli and fungi, respectively. No viral inclusion body was seen. What is the diagnosis? Look on page 1240 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI.

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“…In conclusion, it must not be forgotten that ITB can imitate the CD and pose difficulties in differential diagnosis Discrimination between these two diseases is challenging but important owing to variations in their management and dissemination potential of ITB under immunosuppression applied for CD (7) . TB should be absolutely ruled out in patients with inflammatory bowel disease, especially in patients with low socioeconomic conditions or immigrants coming from TB endemic countries.…”

Section: Dear Editor;mentioning

confidence: 99%

“…Herein, we want to remind you of the case of ITB, which caused difficulty in differential diagnosis by mimicking inflammatory bowel disease (6) . It is estimated that intestinal perforations occur in 1-15% of all patients with abdominal tuberculosis (5)(6)(7) , frequently requiring surgical intervention. Misdiagnosis followed by inadequate treatment may lead to adverse outcomes which require immunosuppressant treatment.…”

Section: Dear Editor;mentioning

confidence: 99%