Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tubercul...

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Autores principales:	M. N. Reshetnikov, D. V. Plotkin, Yu. R. Zyuzya, A. A. Volkov, O. N. Zuban, E. M. Bogorodskaya
Formato:	article
Lenguaje:	RU
Publicado:	Scientific Сentre for Family Health and Human Reproduction Problems 2021
Materias:	intestinal tuberculosis crohn’s disease colonoscopy granuloma ct enterography immunosuppression Science Q
Acceso en línea:	https://doaj.org/article/fb3d320418834e249828360de46d17a0
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spelling	oai:doaj.org-article:fb3d320418834e249828360de46d17a02021-11-23T06:14:47ZDifficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease2541-94202587-959610.29413/ABS.2021-6.5.19https://doaj.org/article/fb3d320418834e249828360de46d17a02021-11-01T00:00:00Zhttps://www.actabiomedica.ru/jour/article/view/3050https://doaj.org/toc/2541-9420https://doaj.org/toc/2587-9596The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.M. N. ReshetnikovD. V. PlotkinYu. R. ZyuzyaA. A. VolkovO. N. ZubanE. M. BogorodskayaScientific Сentre for Family Health and Human Reproduction Problemsarticleintestinal tuberculosiscrohn’s diseasecolonoscopygranulomact enterographyimmunosuppressionScienceQRUActa Biomedica Scientifica, Vol 6, Iss 5, Pp 196-211 (2021)
institution	DOAJ
collection	DOAJ
language	RU
topic	intestinal tuberculosis crohn’s disease colonoscopy granuloma ct enterography immunosuppression Science Q
spellingShingle	intestinal tuberculosis crohn’s disease colonoscopy granuloma ct enterography immunosuppression Science Q M. N. Reshetnikov D. V. Plotkin Yu. R. Zyuzya A. A. Volkov O. N. Zuban E. M. Bogorodskaya Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
description	The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.
format	article
author	M. N. Reshetnikov D. V. Plotkin Yu. R. Zyuzya A. A. Volkov O. N. Zuban E. M. Bogorodskaya
author_facet	M. N. Reshetnikov D. V. Plotkin Yu. R. Zyuzya A. A. Volkov O. N. Zuban E. M. Bogorodskaya
author_sort	M. N. Reshetnikov
title	Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
title_short	Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
title_full	Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
title_fullStr	Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
title_full_unstemmed	Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
title_sort	difficulties in the differential diagnosis of intestinal tuberculosis and crohn‘s disease
publisher	Scientific Сentre for Family Health and Human Reproduction Problems
publishDate	2021
url	https://doaj.org/article/fb3d320418834e249828360de46d17a0
work_keys_str_mv	AT mnreshetnikov difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease AT dvplotkin difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease AT yurzyuzya difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease AT aavolkov difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease AT onzuban difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease AT embogorodskaya difficultiesinthedifferentialdiagnosisofintestinaltuberculosisandcrohnsdisease
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Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

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