Diagnostic Challenge of Crohn’s Disease in a Patient with Clinically Diagnosed Pulmonary Tuberculosis: A Case Report
- 1Institute of Digestive and Liver Diseases, St. Luke’s Medical Center - Global City, Taguig City, Philippines
- 2Institute of Pulmonary Medicine, St. Luke’s Medical Center - Global City, Taguig City, Philippines
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.
Case 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.
Conclusion: 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.
Related
- Growth trajectories in exclusively breastfed infants with clinically diagnosed food allergy: a prospective longitudinal cohort study
- Lymphomas Diagnosed Primarily on Serous Effusion Cytology: Cytology Rises to the Challenge!
- Diagnostic challenge in veterinary pathology: Late term abortion in a cow
- A Diagnostic Challenge in Linear Dermatoses: Differentiating Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) Using Dermoscopy and Reflectance Confocal Microscopy-A Case Report.
- Diagnostic accuracy of Mycobacterium tuberculosis antigen-induced interferon-γ-inducible protein 10 for latent tuberculosis infection among high-risk groups: a systematic review and meta-analysis
BibTeX
@article{pena2026diagnostic,
title = {{Diagnostic Challenge of Crohn’s Disease in a Patient with Clinically Diagnosed Pulmonary Tuberculosis: A Case Report}},
author = {John Paul Escama Dela Peña and Carlos Paolo D. Francisco and Marian Dimabuyu Francisco and Marianne Linley Loo Sy-Janairo},
journal = {Case Reports in Gastroenterology},
year = {2026},
month = sep,
doi = {10.1159/crg/abwag016},
url = {https://doi.org/10.1159/crg/abwag016},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic Challenge of Crohn’s Disease in a Patient with Clinically Diagnosed Pulmonary Tuberculosis: A Case Report
AU - John Paul Escama Dela Peña
AU - Carlos Paolo D. Francisco
AU - Marian Dimabuyu Francisco
AU - Marianne Linley Loo Sy-Janairo
PY - 2026
DA - 2026/09/29
JO - Case Reports in Gastroenterology
DO - 10.1159/crg/abwag016
UR - https://doi.org/10.1159/crg/abwag016
AB - Introduction: Differentiating Crohn’s disease (CD) from gastrointestinal tuberculosis remains challenging in tuberculosis-endemic regions because of overlapping clinical, radiologic, endoscopic, and histopathologic features. Case 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. Conclusion: 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.
SN - 1662-0631
ER -