RT Journal Article
SR Electronic
T1 Crohn’s disease or TB – the perennial question and diagnostic pitfalls
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr0120125620
DO 10.1136/bcr.01.2012.5620
VO 2012
A1 Rudra Krishna Maitra
A1 Tim Bowling
A1 Pradhib Venkatesan
A1 Charles Maxwell-Armstrong
YR 2012
UL http://casereports.bmj.com/content/2012/bcr.01.2012.5620.abstract
AB A previously healthy 28-year old lady from Saudi Arabia presented with recurrent peri-anal abscesses progressing to fistula-in-ano. These were treated with incision and drainages and with setonisation of the fistula. Multiple biopsy and culture specimens were taken to rule out tuberculosis (TB) or Crohn’s disease – all showed granulomatous disease suggestive of either Crohn’s or TB, no mycobacteria were grown. MRI scanning also suggested either TB or Crohn’s disease. Tuberculin skin test was inconclusive and Quantiferon Gold test was negative. Treatment for Crohn’s was started with oral prednisolone – the patient deteriorated and adalimumab (tumour necrosis factor α antagonist) was commenced. With continued deterioration in the absence of intra-abdominal abscesses, a clinical diagnosis of TB was made, Crohn’s treatment suspended and quadruple therapy for TB was initiated. The patient rapidly improved and a delayed re-look histological specimen identified an isolated mycobacterium. Subsequent cultures confirmed drug-sensitive TB. The lady is currently well on TB eradication regimen.