Intestinal tuberculosis mimicking fistulizing Crohn's disease

Area of Science:

• Gastroenterology
• Infectious Diseases
• Internal Medicine

Background:

• Crohn's disease is a chronic inflammatory bowel disease often presenting with complex gastrointestinal manifestations.
• Intestinal tuberculosis (ITB) is an infectious mimic of Crohn's disease, particularly in tuberculosis-endemic regions.
• Endoscopic findings in ITB can overlap significantly with those of Crohn's disease, complicating differential diagnosis.

Observation:

• A patient presented with endoscopic findings suggestive of fistulizing Crohn's disease.
• The patient's clinical presentation and endoscopic evaluation were initially indistinguishable from active Crohn's disease.
• No surgical or immunosuppressive interventions were required.

Findings:

• Complete resolution of symptoms was achieved following a standard course of antituberculosis therapy.
• This case underscores the potential for ITB to present as a surgical mimic within the gastrointestinal tract.
• Histopathological confirmation of tuberculosis was not detailed, but clinical response strongly supported the diagnosis.

Implications:

• Gastroenterologists and physicians must maintain a high index of suspicion for ITB in patients with suspected inflammatory bowel disease, especially in high-prevalence areas.
• Early consideration and appropriate diagnostic workup for ITB can prevent misdiagnosis and unnecessary treatments for Crohn's disease.
• This highlights the need for integrated diagnostic approaches considering both inflammatory and infectious etiologies in complex gastrointestinal presentations.