Combination of Crohn's disease and intestinal tuberculosis. Clinical observation

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Abstract

According to WHO, extrapulmonary forms of tuberculosis (TB) account for 10–15% of the total number of tuberculosis cases worldwide. Crohn's disease (CD) and intestinal tuberculosis have similar clinical, endoscopic and morphological manifestations in many ways. In all cases, when detecting intestinal CD, it is necessary to exclude tuberculosis infection in biopsies using PCR diagnostics. The risk of developing various forms of TB increases with pathogenetic immunosuppressive therapy for inflammatory bowel diseases. A clinical case of a rare combination of the intestinal form of TB and CD is presented, reflecting the difficulty of diagnosing the two pathologies and the difficulty of choosing therapy when they are combined.

About the authors

Irina N. Ruchkina

Loginov Moscow Clinical Scientific Center

Author for correspondence.
Email: oleg7@bk.ru
ORCID iD: 0000-0002-4571-2883

д-р мед. наук, вед. науч. сотр. отд.

Russian Federation, Moscow

Oleg V. Knyazev

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0001-7250-0977

д-р мед. наук, зав. отд-нием

Russian Federation, Moscow

Alina A. Kieva

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0002-8366-101X

лаборант-исследователь отд.

Russian Federation, Moscow

Albina A. Lishchinskaya

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0001-7891-2702

канд. мед. наук, ст. науч. сотр. отд-ния

Russian Federation, Moscow

Sergey G. Khomeriki

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0003-4308-8009

д-р мед. наук, проф., зав. лаб. 

Russian Federation, Moscow

Irina G. Pelipas

Moscow Scientific and Practical Center for Tuberculosis Control

Email: oleg7@bk.ru

зам. зав. 

Russian Federation, Moscow

Konstantin A. Lesko

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0001-9814-0172

врач-рентгенолог 

Russian Federation, Moscow

Alexandra N. Demchenko

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru

врач-гастроэнтеролог

Russian Federation, Moscow

Asfold I. Рafrfenov

Loginov Moscow Clinical Scientific Center

Email: oleg7@bk.ru
ORCID iD: 0000-0002-9782-4860

д-р мед. наук, проф., зав. отд.

Russian Federation, Moscow

References

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Supplementary files

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2. Fig. 1. Computed tomography of the chest organs of patient L. before (a) and after (b) anti-tuberculosis therapy.

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3. Fig. 2. Crohn's disease of the duodenum: a – destruction of intestinal villi and crypts with the formation of deep slit erosion; b – areas of granulomatous inflammation in the proper plate of the mucous membrane of the duodenum; c – giant multinucleated cells in areas of granulomatous inflammation. Stained with hematoxylin and eosin. Magnification: a, b – ×120; c – ×500.

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4. Fig. 3. CT-enterography. Inflammatory changes in the walls of the ileostomy.

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5. Fig. 4. CT-enterography. Inflammatory changes in the colon.

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6. Fig. 5. CT-enterography. Mesenteric lymphadenopathy of the colon.

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7. Fig. 6. Chronic terminal ileitis of Crohn's disease: a – destruction of intestinal villi and crypts with the formation of a slit ulcer in the mucous membrane of the ileum; b – areas of pyloric metaplasia at the edges of the ulcerative defect; c – epithelioid cell granuloma with giant multinucleated cells in the thickness of the muscle layer. Stained with hematoxylin and eosin. Magnification: a – ×90; b, c – ×300.

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8. Fig. 7. Specific granulomatous inflammation in tuberculosis of the colon: a – hyperplasia of lymphoid tissue with multiple epithelioid cell granulomas; b – epithelioid cell granulomas with areas of caseous necrosis. Stained with hematoxylin and eosin. Magnification: a – ×90, b – ×300.

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9. Fig. 8. Transmural granulomatous inflammation in the colon wall in generalized tuberculosis: a – multiple epithelioid cell granulomas in the mucous membrane and submucosal layer; b – lipomatosis and fibrosis of the submucosal layer; c – giant multinucleated cells lying freely among fibrous structures. Stained with hematoxylin and eosin. Magnification: a, b – ×90; c – ×300.

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