P2737 - An Interesting Case of Intestinal Tuberculosis Mimicking Crohn's Disease: A Case Report

Justin Roy P. Sanchez, DO¹, Gabriel Gonzales, DO¹, Monte Troutman, DO^2
1HCA Healthcare, Fort Worth, TX; ²University of North Texas Health Science Center, Fort Worth, TX

Introduction: Intestinal tuberculosis is an underrecognized disease that shares many features with Crohn's disease, making differentiation difficult. This poses a significant problem as initiation of immunosuppressives for an assumed diagnosis of CD in a patient with ITB can lead to worsening of infection and life-threatening consequences.

Case Description/Methods: A 30-year-old Nepali man presented with a febrile illness, right lower quadrant abdominal pain, and productive cough over the course of a month. He immigrated from Nepal 3 years prior to presentation, denying risk factors or symptoms of tuberculosis. No GI bleed was noted other than scant rectal bleeding from hemorrhoids. He had been found to have ileitis with worsening symptoms despite therapy. On presentation to our facility, CT imaging showed mediastinal, axillary, and right iliac lymphadenopathy, a left upper lobe pulmonary infiltrate, and amorphous nodular densities in the right lower lobe. Abdominal CT showed ileocolic thickening. No additional findings were revealed on subsequent MRI enterography. His labs were unremarkable and inflammatory markers were normal. Infectious serology and stool studies were negative. Gastroenterology was consulted for ileitis findings on imaging. Upper endoscopy results were unremarkable. Colonoscopy showed two cratered transverse colon ulcers and 20 cm of inflamed, ulcerated terminal ileal mucosa. Biopsies of the colon were benign while the terminal ileum demonstrated caseating and non-caseating granulomas with negative acid-fast bacilli staining. These results were suggestive of Crohn's disease. TB testing was performed in preparation for biologic therapy. Mycobacterium tuberculosis polymerase chain reaction and complex testing were negative. However, interferon-gamma release assay was found to be positive. A regional lymph node was biopsied and PCR testing of this specimen confirmed tuberculosis. RIPE therapy was promptly initiated.

Discussion: The case presented demonstrates the importance of maintaining a high degree of suspicion for ITB when evaluating cases of suspected CD. Particular efforts to rule out the disease should be made if a high pretest probability exists. This is especially relevant amongst patients from endemic regions. Misdiagnosis risk is increased due to similar presentations between the two disease states and relatively low sensitivity of current ITB testing. Lastly, due to the need for relative immunosuppression in CD treatment, misdiagnosis may directly cause adverse outcomes in ITB.


Disclosures:


Justin Roy P. Sanchez, DO¹, Gabriel Gonzales, DO¹, Monte Troutman, DO². P2737 - An Interesting Case of Intestinal Tuberculosis Mimicking Crohn's Disease: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.