Crohn’s disease or intestinal tuberculosis: A diagnostic dilemma

Amit Dashputra¹, Ira Shah^2
1Seth G S Medical College, Mumbai, India and Pediatric Gastroenterology and Infectious Diseases, Levioza Health Care, Mumbai, India, ²

Address for Correspondence: Amit Dashputra, Seth G S Medical College, Mumbai, India. Email: amitdashputra@outlook.com

Clinical Problem:
A 12-year-old boy presented with pain in the abdomen for 5 months and a weight loss of 18 kg in the same period. He used to pass non-bloody loose stools with mucus 2-3 times a day. Examination showed tenderness over the entire abdomen. Investigations showed hemoglobin 9.6 g/dL, white blood cell count 9000/cumm (56% polymorphs, 40% lymphocytes), platelets 9,88,000/cumm, ESR 32 mm at end of 1 hour. Stool examination showed 40-50 pus cells/hpf and 18-20 red blood cells/hpf. Fecal Calprotectin was more than 800µg/mg. A colonoscopy revealed ulcers in the sigmoid colon, transverse colon, ascending colon, ileocaecal valve, caecum, and terminal ileum. Histopathology of ileocaecal biopsy showed surface ulcerations, moderate lymphoplasmacytic, as well as neutrophilic, infiltrate with multinucleated giant cells and occasional granulomas. Colonic mucosa had multinucleated giant cells and acid-fast staining was negative. Quantiferon TB Gold and tuberculin skin test (TST) was negative. ANA was negative.

How to differentiate between Crohn’s disease and intestinal tuberculosis?