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A Challenging Case of the Forgotten Abdominal Tuberculosis in the Developed World

Sara Henen1, Christine Denton1, Aaron Miller2,3

  • 1From the Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO.

JPGN Reports
|May 19, 2023
PubMed

Insights

Differentiating abdominal tuberculosis (TB) from Crohn's disease (CD) is crucial. Early suspicion and empirical treatment for TB in children can prevent severe complications from misdiagnosis.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Immunology

Background:

  • Differentiating abdominal tuberculosis (TB) from Crohn's disease (CD) is clinically challenging but vital.
  • Misdiagnosis can lead to catastrophic disseminated miliary TB due to inappropriate immunosuppressive therapy.

Observation:

  • A 5-year-old male presented with failure to thrive, ascites, and diarrhea, mimicking CD.
  • Subtle clinical, endoscopic, and histologic features were key in diagnosis.

Findings:

  • Diagnostic hallmarks like caseating necrosis, positive acid-fast bacillus (AFB) smear/culture, and necrotic lymph nodes are often absent.
  • Vigilance in screening pediatric patients with elusive symptoms is essential.

Implications:

  • Suspect TB in pediatric patients with unexplained gastrointestinal symptoms.
  • Empirical antituberculous treatment may be necessary for diagnosis when definitive evidence is scarce.

Keywords:
Crohn’s diseaseIntestinePediatricsTuberculosis

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