EP328 - TUBERCULOSIS MIMICKING AS CROHN’S DISEASE: A CASE REPORT (ID 1081)
Abstract
Title of Case:
Tuberculosis
Background:
Patients with immune deficiencies and young children are susceptible to disseminated forms of tuberculosis. The presentation of disseminated TB is diverse depending on the affected organs and can mimic other disease.
Case Presentation Summary:
An 11-year old boy with anaemia and increased calprotectin was referred for a colonoscopy because of abdominal pain, diarrhoea and weight loss for three months. Colonoscopy revealed ileocecal inflammation suggestive of Crohn’s disease. After the procedure he developed fever and respiratory symptoms (dyspnea, crackles and reduced oxygen saturation). Chest X-ray demonstrated alveolar consolidations and a reticular enhanced lung parenchyma. With the working diagnosis of aspiration pneumonia amoxicillin/clavulanic was initiated. In the absence of improvement treatment was switched to ceftriaxone/metronidazole after 4 days and to meropenem 3 days later. Gradual clinical and biochemical improvement was noted. Gastro-intestinal biopsies showed chronical inflammation with multiple granuloma´s, however not suspected of Crohn’s disease. Tuberculosis was in the differential diagnosis. Because of persistent gastro-intestinal symptoms corticosteroids were initiated together with precautionary concurrent TB treatment. All investigations for TB (TST, IGRA, cultures on blood/liquor/gastric/BAL and PCR’s on liquor and faeces) were negative. A positive evolution was noted on a CT scan, but residual abnormalities could be explained by TB. Two months after presentation the TST of his 10-month-old sibling turned positive, indicating recent family exposure to open tuberculosis. Corticosteroids were tapered to stop and TB treatment was continued for 9 months.
Learning Points/Discussion:
Intestinal tuberculosis can mimic Crohn’s disease. While improvement on antibiotics can be used as an argument against tuberculosis, physicians should be aware of meropenem’s activity against tuberculosis. TST conversion in a family member indicates recent TB exposure, a so-called sentinel event, which can help confirming the diagnosis if all other investigations return negative.
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