Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clinical Cases. Sep 16, 2016; 4(9): 273-280
Published online Sep 16, 2016. doi: 10.12998/wjcc.v4.i9.273
Tuberculosis terminal ileitis: A forgotten entity mimicking Crohn’s disease
Simona Gurzu, Calin Molnar, Anca Otilia Contac, Annamaria Fetyko, Ioan Jung
Simona Gurzu, Calin Molnar, Anca Otilia Contac, Annamaria Fetyko, Ioan Jung, Department of Pathology, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania
Author contributions: Gurzu S wrote the manuscript and carried out the study design; Molnar C handled the clinical aspects of the case; Contac AO performed the autopsy and interpretation of the macroscopic data; Fetyko A interpretated the histological data and and checked the English quality; Jung I performed the histological examination and coordinated the study design and the draft of the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of Medicine and Pharmacy, Tirgu-Mures, Romania.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Simona Gurzu, MD, PhD, Professor, Head of Research Laboratory, Department of Pathology, University of Medicine and Pharmacy, 38 Ghe Marinescu Street, 540139 Tirgu-Mures, Romania. simonagurzu@yahoo.com
Telephone: +40-745-673550 Fax: +40-265-210407
Received: April 23, 2016
Peer-review started: April 24, 2016
First decision: June 6, 2016
Revised: June 8, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 16, 2016
Processing time: 137 Days and 14.2 Hours
Abstract

Intestinal tuberculosis (TB) is an uncommon lesion for which differential diagnosis can be difficult. We present a case of a 53-year-old male and a systematic review of the literature, from clinical symptoms to differential diagnosis, unusual complications and therapy. The patient was admitted to the hospital with signs of acute abdomen as a result of a perforated terminal ileitis. Based on the skip lesions of the terminal ileum and cecum, Crohn’s disease (CD) was clinically suspected. An emergency laparotomy and right colectomy with terminal ileum resection was performed and systematic antibiotherapy was prescribed. The patient’s status deteriorated and he died 4 d after the surgical intervention. At the autopsy, TB ileotyphlitis was discovered. The clinical criteria of the differential diagnosis between intestinal TB and CD are not very well established. Despite the large amount of published articles on this subject, only 50 papers present new data regarding intestinal TB. Based on these studies and our experience, we present an update focused on the differential diagnosis and therapy of intestinal TB. We highlight the importance of considering intestinal TB as a differential diagnosis for inflammatory bowel disease. Despite the modern techniques of diagnosis and therapy, the fulminant evolution of TB can still lead to a patient’s death.

Keywords: Ileitis; Autopsy; Ileotyphlitis; Crohn’s disease; Tuberculosis; Inflammatory bowel disease; Ischemic colitis

Core tip: In this paper, we performed a case-based update of data regarding intestinal tuberculosis. In the case the patient was hospitalized with suspicion of Crohn’s disease and ileal perforation but the autopsy revealed a tuberculous ileotyphlitis. The necessity of a complete differential diagnosis and not forgotten the tuberculosis as a potential cause of death was highlighted in the paper.