A Case Report: Fatal Case of Disseminated Tuberculosis in a 24-year-old Male Patient with Crohn’s Disease

Abstract

Introduction: Cohn’s disease (CD) is an idiopathic disorder involving the GI tract. The differential diagnosis of CD is broad and includes infectious colitis, ulcerative colitis intestinal TB (iTB), etc. Due to the lack of standards in a definitive diagnosis, discrimination between iTB and CD has long been a diagnostic challenge.

Case presentation: A 24-year-old male patient, known to have Crohn’s disease, treated with daily prednisone 60 mg and mesalamine since 1 week (due to a flare-up), presented for 2 days history of severe exacerbating diffuse abdominal pain, along with generalized weakness, weight loss, watery diarrhea, vomiting, decreased oral intake, and high-grade fever (39 °C). An urgent abdominopelvic CT scan with IV contrast showed significant pneumo-peritoneum and minimal fluid distributed inside the abdomen, denoting bowel perforation. The patient underwent an urgent laparotomy. Intraoperative findings were an abdominal cavity full of fecal material, multiple small bowel perforations, and entero- enteric fistulas. 1.5 meters of the small intestine was resected. Pathology showed iTB. TB PCR of deep tracheal aspirate was positive as well. The patient was started on anti-TB treatment for disseminated tuberculosis affecting the lungs and GI tract. Unfortunately, the patient developed a septic pulmonary embolism on day 7 post-op and was announced dead on day 9.

Conclusion: Our case emphasizes that the two chronic granulomatous diseases (CD and iTB) have similarities that make the distinction between them difficult and yet crucial because of possible repercussions of a misdiagnosis. It also highlights the importance of latent TB screening before starting the confirmed CD immunosuppressive treatment especially in underdeveloped countries, as the patient could have a reactivation of latent TB upon initiation of immunosuppressive therapy.