Intestinal tuberculosis versus Inflammatory Bowel Diseases: a never-ending challenge

Area of Science:

• Gastroenterology
• Infectious Diseases
• Immunology

Background:

• Inflammatory Bowel Diseases (IBD) and intestinal tuberculosis (ITB) present with overlapping clinical, radiological, endoscopic, and histological features, complicating diagnosis.
• Misdiagnosis of IBD in patients with ITB can lead to immunosuppressive therapy, potentially causing disseminated Mycobacterium tuberculosis (MTB) infection.
• Tuberculosis screening is crucial in endemic areas and for specific patient groups, including pregnant women, to prevent adverse outcomes.

Purpose of the Study:

• To report a challenging case of a pregnant woman with ITB misdiagnosed as Crohn's disease (CD) on prolonged steroid treatment.
• To emphasize the need for tuberculosis screening in pregnant women and individuals from TB-endemic regions.
• To discuss the impact of prolonged steroid treatment on the histological presentation of ITB and outline optimal clinical management strategies for ITB.

Main Methods:

• Case report detailing the diagnostic journey of a pregnant patient with ITB initially misdiagnosed as CD.
• Review of literature concerning TB screening protocols, effects of immunosuppression on TB, and histological changes in steroid-treated TB.
• Clinical management strategies for intestinal tuberculosis were analyzed.

Main Results:

• The patient's ITB progressed from localized to disseminated disease under prolonged steroid treatment for presumed CD.
• Steroid therapy significantly altered the histological findings of the tuberculosis, further complicating the diagnosis.
• The case underscores the critical need for early and accurate diagnosis of ITB to guide appropriate treatment and prevent complications.

Conclusions:

• Prompt tuberculosis screening is essential for pregnant women and those from endemic regions presenting with IBD-like symptoms.
• Prolonged steroid use in misdiagnosed TB can lead to disease dissemination and mask typical histological features.
• Optimal clinical management of ITB requires a high index of suspicion, timely diagnosis, and avoidance of immunosuppression in suspected or confirmed cases.