{
  "abstract": "Introduction: Differentiating Crohn’s disease (CD) from gastrointestinal tuberculosis remains challenging in tuberculosis-endemic regions because of overlapping clinical, radiologic, endoscopic, and histopathologic features.\n\nCase Presentation: A 21-year-old man presented with substantial unintentional weight loss without pulmonary or gastrointestinal symptoms. Chest computed tomography showed bilateral centrilobular nodules with a tree-in-bud pattern, while abdominal imaging demonstrated long-segment ileocolitis. Despite a negative tuberculosis immunoassay, pulmonary tuberculosis was diagnosed clinically, and the intestinal findings were initially attributed to possible gastrointestinal tuberculosis. Colonoscopy showed multifocal stricturing ulceration, nodularity, and friability involving the colon and rectum. Intestinal biopsy specimens demonstrated severe chronic active inflammation; Mycobacterium tuberculosis polymerase chain reaction and acid-fast bacillus staining were negative. During a standard 6-month antituberculosis regimen, the patient developed intermittent abdominal pain and recurrent vomiting. Repeat chest computed tomography showed resolution of the pulmonary nodules, whereas colonoscopy after 5 months demonstrated persistent longitudinal ulcers, pseudopolyps, skip areas, and stricturing from the terminal ileum to the rectum. Histopathology showed severe chronic active colitis with cryptitis, crypt abscesses, tissue eosinophilia, and rare non-necrotizing granulomas. A Crohn’s Disease Activity Index score of 229 and the overall clinicopathologic findings favored ileocolonic stricturing CD. Mesalamine and ustekinumab were initiated, with resolution of abdominal pain and vomiting, weight gain, and a decline in fecal calprotectin from 1,740 to 320 µg/g. Follow-up colonoscopy approximately 1 year later (week 48 of ustekinumab) showed resolution of the previous extensive ulceration and friability, with pseudopolyposis and ileocecal valve narrowing. Biopsies demonstrated focal mild cecal cryptitis without active inflammation in the remaining sampled colonic segments or distal terminal ileum.\n\nConclusion: This case underscores the diagnostic challenge of distinguishing CD from gastrointestinal tuberculosis in a patient with clinically diagnosed pulmonary tuberculosis. Persistent ileocolonic inflammation despite adequate antituberculosis therapy, repeatedly negative intestinal tuberculosis studies, and endoscopic and histopathologic features favoring CD should prompt timely diagnostic reassessment and appropriate disease-specific treatment.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Digestive and Liver Diseases, St. Luke’s Medical Center - Global City, Taguig City, Philippines",
    "Institute of Pulmonary Medicine, St. Luke’s Medical Center - Global City, Taguig City, Philippines"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "John Paul Escama Dela Peña",
      "orcid": "0009-0000-7826-3861"
    },
    {
      "affs": [
        0
      ],
      "name": "Carlos Paolo D. Francisco",
      "orcid": "0000-0002-2802-3955"
    },
    {
      "affs": [
        1
      ],
      "name": "Marian Dimabuyu Francisco"
    },
    {
      "affs": [
        0
      ],
      "name": "Marianne Linley Loo Sy-Janairo",
      "orcid": "0000-0002-1829-2801"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dcp5wyd51z8ze.bib",
  "cited_by": 0,
  "doi": "10.1159/crg/abwag016",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13719202/",
  "id": "dcp5wyd51z8ze",
  "issns": [
    "1662-0631"
  ],
  "landing_url": "https://doi.org/10.1159/crg/abwag016",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Single Case"
    ],
    [
      "openalex",
      "1311|Inflammatory Bowel Disease"
    ]
  ],
  "openalex": "W7215126121",
  "pdf_url": "https://karger.com/crg/article-pdf/doi/10.1159/crg/abwag016/4589541/000554445.pdf",
  "pmcid": "PMC13719202",
  "pmid": "42960385",
  "published": "2026-09-29",
  "publisher": "Karger Publishers",
  "ris": "https://research.draconitic.com/paper/dcp5wyd51z8ze.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T12:23:04Z",
      "native_id": "PMC13719202",
      "source": "pmc",
      "url": "https://doi.org/10.1159/crg/abwag016"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:1311|Inflammatory Bowel Disease",
      "subfield": "genetics-genomics"
    }
  ],
  "title": "Diagnostic Challenge of Crohn’s Disease in a Patient with Clinically Diagnosed Pulmonary Tuberculosis: A Case Report",
  "title_text": "Diagnostic Challenge of Crohn’s Disease in a Patient with Clinically Diagnosed Pulmonary Tuberculosis: A Case Report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:23:04Z",
  "url": "https://research.draconitic.com/paper/dcp5wyd51z8ze",
  "venue": "Case Reports in Gastroenterology",
  "versions": []
}