S2302 Empiric Anti-Tuberculosis Treatment as a Way to Help Solve Diagnostic Challenges Between Intestinal Tuberculosis and Crohn’s Disease—A Case Presentation

INTRODUCTION: Crohn’s disease is a great mimicker of intestinal tuberculosis and a high clinical suspicion along with other supporting clinical, endoscopic, imaging and histopathologic features is required to accurately diagnose and treat patients. Overlapping symptoms, laboratory and imaging findings, and endoscopic features makes differentiating ITB and CD challenging. CASE DESCRIPTION/METHODS: A 42-year-old Ethiopian male presented to the Emergency Room with a 2-month history of peri-umbilical abdominal pain. He also reported subjective fevers, night sweats and an 8-pound unintentional weight loss. He was born in Ethiopia but had lived in the United States for 7 years. His last foreign travel was 4 years prior to presentation. CBC was unremarkable. CMP was within normal limits. HIV testing was negative. ESR was elevated a 55MM/HR. CRP was within normal limits at 7.5 mg/L. Initial workup included CT A/P which demonstrated focal narrowing within the ascending colon with surround inflammatory fat stranding and ascites with associated chronic stasis of the proximal small bowel loops. He underwent diagnostic thoracentesis revealing transudative pleural fluid. AFB analysis of fluid was negative. He underwent a diagnostic EGD and Colonoscopy. The ascending colon polypoid ulcerative lesion was demonstrated to have acute on chronic ulceration with cryptitis, crypt drop out, mucosal fibrosis and patchy mucosal eosinophilia. AFB stains were negative. He was then evaluated by the infectious disease team the strong suspicion for Tuberculosis. He completed 6 months of directly observed therapy. His symptoms began to improve early on during therapy. He then had a repeat colonoscopy with a resolution of the findings performed 6 months after completed of directly observed therapy. DISCUSSION: Differentiating between ITB and Crohn’s disease is particularly difficult and often presents a real challenge, particularly when immigrant patients from TB endemic area. An incorrect diagnosis may prolong the disease and favor complications such as intestinal perforation or worsening of TB if immunosuppressive medication started. However, in some situation, despite thorough work up, definitive diagnosis will be a challenge. In doubtful cases, initiating anti-TB treatment with a re-evaluation of the clinical response may be effective. It is particularly important to evaluate the endoscopic results, since it has been shown that the great majority of ITB patients present endoscopic cure following treatment, unlike CD patients.Figure 1.: Ascending colon Superficial Ulcerations before treatment.Figure 2.: Ascending colon after anti-tuberculosis treatment.Figure 3.: Able to pass to terminal ileum after anti-tuberculosis treatment.