INTESTINAL TUBERCULOSIS IN A PATIENT WITH CROHN’S DISEASE: DIAGNOSTIC DIFFICULTY

Differentiating Crohn’s disease (CD) from intestinal tuberculosis (IT) is challenging due to overlapping clinical, histological, and endoscopic findings. Screening for latent tuberculosis with PPD or IGRA is essential before immunosuppression; however, anergy in active CD may yield false-negative results, not excluding IT or latent infection. A 26-year-old man presented with intense abdominal pain, fever, diarrhea with hematochezia and melena for one week, and a 15-kg weight loss over six months. Diagnosed with CD two months earlier, he was on mesalamine and prednisone. Initial colonoscopy showed cryptitis without granulomas; PPD was negative. Imaging revealed ileocecal thickening. After transient improvement, he returned with respiratory symptoms. Chest CT showed centrilobular micronodules and bronchiectasis. Sputum smear was positive, and intestinal biopsy confirmed tuberculosis. RIPE therapy was initiated, but the patient developed intestinal obstruction, perforation, peritonitis, and died of refractory septic shock. Histopathology showed transmural granulomatous inflammation with caseous necrosis and Ziehl-Neelsen positivity. This case illustrates diagnostic challenges in differentiating CD from IT, especially in endemic regions, highlighting the need for sensitive screening strategies.