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Crohn's disease with positive Ziehl-Neelsen stain: Three case reports
1Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Abstract:
Because of the similarity of the clinical symptoms, endoscopic, and pathological features, the differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITB) remains difficult, especially in a high-incidence area of tuberculosis (TB). Here we reported three patients with positive Ziehl-Neelsen stain in endoscopic mucosal biopsy specimens. They had a poor response to anti-TB therapy but a good response to immunosuppresses, infliximab, or surgery, and were finally diagnosed as CD. It was not clear that they were CD concomitant with mycobacteria infection or CD induced by mycobacteria infection. Further studies including more clinical cases and related animal models are needed. Our cases highlight the importance of considering the presence of CD in patients with positive Ziehl-Neelsen stain, which were failure to respond to anti-TB treatment.
Insights
Diagnosing Crohn's disease (CD) and intestinal tuberculosis (ITB) is challenging. Positive Ziehl-Neelsen stains in patients with suspected ITB who don't respond to anti-TB therapy may indicate CD.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pathology
Background:
- Differentiating Crohn's disease (CD) from intestinal tuberculosis (ITB) is clinically challenging due to overlapping symptoms and pathological findings.
- This diagnostic difficulty is amplified in regions with a high incidence of tuberculosis (TB).
Observation:
- Three cases are presented where patients had positive Ziehl-Neelsen stains on endoscopic biopsies, initially suggesting ITB.
- These patients exhibited a poor response to standard anti-TB treatments.
- However, they showed significant improvement with immunosuppressive therapy, infliximab, or surgical intervention.
Findings:
- The final diagnoses for these patients were established as Crohn's disease (CD).
- The relationship between Mycobacterium infection and CD in these cases remains unclear (concomitant infection vs. infection-induced CD).
Implications:
- Positive Ziehl-Neelsen stains in patients with suspected ITB who are refractory to anti-TB treatment should prompt consideration of Crohn's disease.
- Further research with larger cohorts and animal models is necessary to elucidate the complex interplay between mycobacteria and CD.
- These findings underscore the importance of a comprehensive diagnostic approach beyond initial staining results.