Is histopathological examination sufficient in the diagnosis of Crohn's disease in the case of suspected tuberculosis?

Year 2011, Volume: 10 Issue: 2, - , 01.08.2011

Kadriye Kart Yaşar Filiz Pehlivanoğlu Gönül Şengöz Zeynep Tatar

Abstract

Tuberculosis and Crohn's disease are chronic diseases affecting similar parts of the gastrointestinal system, and they cannot be differentiated clinically. Histopathological examination of a biopsy remains a gold standard for Crohn's disease, but this procedure may not be sufficient for diagnosis of intestinal tuberculosis. In this study, a 19-year-old patient with intestinal tuberculosis is presented; the diagnosis was made by direct microscopic examination, culture and polymerase chain reaction positivity for tuberculosis in a secondary colonoscopic examination. In all patients admitted with fever, chronic diarrhea and abdominal pain, intestinal tuberculosis should be kept in mind, and microbiological tests should be performed due to the similar clinical findings and same affected parts of the gastrointestinal system, even if histopathological results are compatible with Crohn's disease.

Keywords

Crohn's disease, tuberculosis, differentiation, histopathology

Tüberküloz ve Crohn hastalığı ayırımında histopatolojik inceleme yeterli midir?

Abstract

Tüberküloz ve Crohn hastalığı, gastrointestinal sistemin benzer bölümlerini etkileyen kronik hastalıklar olup, klinik olarak ayırdedilemezler. Biyopsi materyalinin histopatolojik incelemesi Crohn için, hala altın standart olmasına rağmen, tüberküloz için her zaman yeterli olmayabilir. Bu çalışmada, Crohn hastalığı tanısıyla 4 aydır izlenen ve tekrarlanan kolonoskopide alınan örneğin mikroskobik incelemesinde aside rezistan basil görülmesi, kültür ve polimeraz zincir reaksiyonu pozitişiği ile tanı konulabilen 19 yaşındaki intestinal tüberkülozlu olgu sunulmuştur. Ateş, karın ağrısı, kronik diyare ile başvuran hastalarda barsak biyopsi sonucu Crohn ile uyumlu gelse bile; aynı bölgeyi tutması ve benzer klinikle seyretmesi nedeniyle intestinal tüberküloz akılda tutulmalı ve tanıya yönelik mikrobiyolojik tetkikler mutlaka yapılmalıdır.

Keywords

Crohn hastalığı, histopatoloji, intestinal tüberküloz, kolonoskopi, tüberküloz

References

• Kucukardali Y, Oncul O, Cavuslu S, et al. The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study. Int J Infect Dis 2008; 12: 71-9.
• Türkiye’de Verem Savaşı, 2007 Raporu. S. B. Verem Savaş Daire Başkanlığı. Ankara: 2007.
• Moulding T. Pathogenesis, pathophsyiology, and immunology: cli- nical orientations. In: Schlossberg D (Ed). Tuberculosis and nontu- berculous mycobacterial infections, 5thed. Philadelphia, W. B. Sa- unders, 2006; 48-56.
• Pulimood AB, Amarapurkar DN, Ghoshal U, et al. Differentation of Crohn’s disease from intestinal tuberculosis in India in 2010. World J Gastroenterol 2011; 17: 433-43.
• Arnold C, Moradpour D, Blum HE. Tuberculous colitis mimicking Crohn’s disease. Am J Gastroenterol 1998; 93: 2294-6.
• Bayramicli UO, Dabak G, Dabak R. A clinical dilemma: abdominal tuberculosis. World J Gastroenterol 2003; 9: 1098-101.
• Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tubercu- losis mimicking Crohn's disease: case report. BMC Gastroenterol 2002; 2: 10.
• Gan HT, Chen YQ, Ouyang Q, et al. Differantiation between intes- tinal tuberculosis and Crohn's disease in endoscopic biopsy speci- mens by polymerase chain reaction. Am J Gastroenterol 2002; 97: 1446-51.
• Basar O, Koklu S, Koksal D, et al. Intracranial tuberculomas in a no- nimmuncompromised patient with abdominal tuberculosis misdi- agnosed as Crohn's disease. Dig Dis Sci 2005; 50 : 1279-82.