PMC4493258_01
Image studies of the patient with intestinal tuberculosis initially misdiagnosed as Crohn's disease. a-c Images for making the initial diagnosis of Crohn's disease. a Coronal view of abdominal computed tomography showed skip lesions with interrupted dilatation of the small bowel, and one stricture point at the terminal ileum with the dilated proximal intestine (arrow); b Initial barium radiographic study of the intestine showed segmental narrowing of the ileum, which favored post-inflammatory focal stricture (arrow); c Colonoscopic examination showed polypoid lesion at the terminal ileum. d
D1 Barium radiographic study of our patient after completion of anti-tuberculous treatment showing patent intestinal structure; D2 Barium radiographic study of another 20-year-old male diagnosed with Crohn's disease showing typical ileocecal valve involvement with cobblestone appearance.
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Fig1
ACT showed skip lesions throughout the small bowel, and suspected healed enteroenteric fistula with multifocal mesenteric adhesion (Figure 1a). Barium radiographic study revealed segmental narrowing of ileum which favored post-inflammatory focal stricture (Figure 1b). Colonoscopic examination showed the presence of polypoid lesions in the terminal ileum (Figure 1c), of which two pieces were biopsied. Follow-up barium radiographic examination of the intestine (Figure 1d, left) showed no definite residual lesion after completion of his 6-month-course of anti-TB treatment.
Histopathological examination of the surgical specimen. a The presence of acid-fast bacilli in the bowel (acid-fast stain); b granulomatous inflammation with caseating necrosis (H&E stain).
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Fig2
The pathologic report showed granulomatous inflammation with the presence of acid-fast bacilli at the perforated site (Figure 2).