Abstract

Background: A 35/M admitted with complaints of abdomen distension and leg swelling for one week and dark colored stools for 4 days. Not a known case of DM/ SHT/ heart diseases. No history of TB in the past. Patient is a chronic alcoholic. He was severely pale, had bilateral pitting pedaledema, per abdomen examination showed fluid in the peritoneal cavity. Patient was not icteric.

Investigations: Investigations were done. Blood count revealed severe anemia (Hb4g/dL), hypoproteinemia (T. protein – 5.9, S. Albumin -2.9). Stool Occult Blood Test – positive. Coagulation profile – normal. CECT abdomen and pelvis taken – showed diffuse edematous wall thickening noted in Caecum, Ascending colon and right hepatic flexure. Multiple necrotic mesenteric and common iliac nodes noted. OGD scopy revealed corpus gastritis. Video colonoscopy showed inflamed edematous mucosa with ulceration in Caecum, Ascending colon and terminal Ileum with skip lesions. Biopsy taken. Biopsy sample turned out to be positive for MTB in CBNAAT test. HPE showed non-specific colitis.

Management: Patient was diagnosed with intestinal TB and started on category 1 ATT according to RNTCP guidelines. He was transfused 2 units PRBCs and given iron supplementation. Patient gradually improved, his pedal edema decreased. He was discharged after 30 days with ATT therapy and advised follow up.

Conclusion: Distinguishing intestinal TB and Crohn’s disease is a huge diagnostic challenge. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. A guideline based approach in a patient with granulomatous colitis should be helpful in preventing unnecessary ATT in a patient with Crohn’s disease especially in a developed country. In developing countries where TB is endemic, starting ATT would be appropriate in times of diagnostic challenge.

Keywords: Anemia, Colonoscopy, Crohn’s disease, Granulomatous colitis.