Differentiating Crohn’s disease from intestinal tuberculosis

Figure 1 Endoscopic images. A: Longitudinal ulcer in a patient with Crohn’s disease; B: Coblestoning in a patient with Crohn’s disease; C: Deep ileal ulcer in a patient with Crohn’s disease; D: Transverse ulcer with a stricture in a patient with intestinal tuberculosis; E: Ulcerated bulky ileocaecal valve in a patient with intestinal tuberculosis.

Figure 2 Colonic biopsy. A: Patchy distortion of crypt architecture (arrows) (× 40). B: Features of focal active cryptitis are noted (arrow) (× 200). C: Colonic biopsy in a case of Crohn’s disease shows pericrypt mucosal microgranuloma (arrow) (× 40). D: Ileal biopsy in a case of ileocaecal tuberculosis shows blunting of ileal villi with crypt branching (arrow) (× 100). E: Serosal confluent necrotizing epithelioid cell granulomas (arrows) were noted (× 40). F: Photomicrograph showing an epithelioid cell granuloma with central necrosis (arrow) and Langhan’s giant cells (× 200).

Figure 3 Coronal computed tomography images in patients with Crohn’s disease. A: Long segment ileal thickening; B: Mural stratification (arrow) and increased visceral fat (arrowhead); C: Comb sign; D: Axial computed tomography image in a patient with intestinal tuberculosis demonstrating short segment ileocaecal thickening (arrow) with necrotic lymph node (arrowhead); and E: Coronal magnetic resonance image in a patient with intestinal tuberculosis showing ileocaecal thickening (arrowhead) and necrotic lymph node (arrow).

Figure 4 Algorithm for following a patient on therapeutic anti-tubercular therapy trial. ATT: Anti-tubercular therapy; CD: Crohn’s disease; ITB: Intestinal tuberculosis.