Ieva Stainytė1, Martyna Vyčaitė1, Irma Kuliavienė2
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2Hospital of the Lithuanian University of Health Sciences Kauno klinikos, Department of Gastroenterology, Kaunas, Lithuania
Background. Gastrointestinal (GI) tuberculosis (TB) is a relatively rare form of tuberculosis that can affect the peritoneum, abdominal organs or the abdominal lymphatic system. As an extrapulmonary form, intestinal tuberculosis accounts for 2% of cases of this disease worldwide. Intestinal damage caused by Mycobacterium tuberculosis (M. tuberculosis) presents with nonspecific complaints such as constitutional symptoms, abdominal pain and changes in bowel movements. The most common site of damage is the ileocecal valve. People with immunosuppressive conditions are at greater risk of developing this disease.
Clinical case. This article presents a clinical case of a patient in whom the initial diagnosis of Crohn’s disease (CD) and treatment with glucocorticoids were incorrect. Persistent symptoms led to consideration of ineffective treatment and alternative diagnoses, therefore, it was decided to perform a repeated fibrocolonoscopy (FCS). Ultimately, only a positive culture for M. tuberculosis confirmed the diagnosis of intestinal tuberculosis.
Conclusions. This clinical case reflects the complicated diagnosis of intestinal tuberculosis and its differentiation from Crohn’s disease, which is determined by non-specific symptoms and insufficiently sensitive standard tests. A detailed examination, including fibrocolonoscopy with multiple biopsies for histological examination and microbiological identification of M. tuberculosis, is important for establishing the diagnosis. Multiplex polymerase chain reaction (PCR) testing is recommended when possible.
Keywords: gastrointestinal tuberculosis, intestinal tuberculosis, M. tuberculosis.