Süleyman ÇELİK, İlgaz KAYILIOĞLU, Cihangir AKYOL

İntestinal Tüberküloz: Tanısal Zorlukları ile Beraber Nadir Bir Olgu

Tüberküloz, artan sıklığı ile ülkemizde hala mortalite ve morbiditenin önemli bir nedenidir. Gastrointestinal sistemin aynı bölümlerini etkilemeleri, ülseratif lezyonlarla seyretmeleri, semptom ve muayene bulgularının benzer olması gibi nedenlerle intestinal tüberküloz ve Crohn hastalığı klinik olarak ayırt edilemeyebilirler. Olguda karın ağrısı nedeniyle hastaneye başvuran ve zorlu tanı aşamalarını takiben intestinal tüberküloz tanısı alan 31 yaşında kadın hasta sunulmuştur. Sadece intestinal bulguları olan hastalarda, Crohn hastalığı düşünülerek verilen antiinflamatuvar ve immünomodülatör tedavi hastalığın ilerlemesine neden olabileceği unutulmamalıdır. Bu nedenle ayrıntılı testlerle intestinal tüberküloz tanısı irdelenmelidir

Intestinal Tuberculosis: A Rare Disease with Diagnostic Difficulty

Tuberculosis is an important cause of mortality and morbidity in Turkey with steadily increasing incidence. By effecting the same part of gastrointestinal tract and causing ulserative lessions, symptoms and examination findings, intestinal tuberculosis and Crohn’s disease are clinically indistinguishable. In this case, we present a successfully treated case of 31 year old woman with intestinal tuberculosis, despite the diagnostic difficulties. Patients who have only abdominal symptoms may face the risk of getting treated like inflammatory bowel diseases with antiinflammatory and immunomodulator agents which might cause a progression in the disease. Diagnosis of intestinal tuberculosis should be studied carefully

Keywords:

Crohn’s disease, gastrointestinal, tuberculosis,

PDF

___

Kochi A. The global tuberculosis situation and the new control strategy of the World Health Organization. Tubercle. 1991;72:1-6.
Farer LS, Lowell AM, Meador MP. Extrapulmonary tuberculosis in the United States. Am J Epidemiol. 1979;109:205-17.
Miah AR, Sharma YR, Rahman MT, Raihan A, Roy PK, Hasan M. Clinicopathological profile of patients with abdominal tuberculosis. J Nepal Health Res Counc. 2011;9:169-75.
Cai J, Li F, Zhou W, Luo HS. Ileocecal ulcer in central China: case series. Dig Dis Sci. 2007;52:3169-73.
Sibartie V, Kirwan WO, O’Mahonya S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn’s disease: lessons relearned in a new era. Eur J Gastroenterol Hepatol. 2007;19:347-9.
Park YS, Jun DW, Kim SH, et al. Colonoscopy evaluation after short-term anti-tuberculosis treatment in nonspecific ulcers on the ileocecal area. World J Gastroenterol. 2008;14:5051-8.
Wong WM, Lai KC, Yiu WC, Wong BC, Chan FL, Lai CL. Intestinal tuberculosis mimicking fistulizing Crohn’s disease. J Gastroenterol Hepatol. 2007;22:137-9.
Li X, Liu X, Zou Y, Ouyang C, Wu X, Zhou M, Chen L, Ye L, Lu F. Predictors of clinical and endoscopic findings in differentiating Crohn’s disease from intestinal tuberculosis. Dig Dis Sci. 2011;56:188-96.
Ha HK, Junf JI, Lee MS, Choi BG, Lee M, Kim YH, Kim PN, Auh YH. CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. AJR Am J Roentgenol. 1996;167:743-8.
Ha HK, Ko GY, Yu ES, Yoon K, Hong WS, et al. Intestinal tuberculosis with abdominal complications: radiologic and pathologic features. Adbom Imaging. 1999;24:32-8.
Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72:1761-8.
Pulimood AB, Amarapurkar DN, Ghoshal U, et al. Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol. 2011;17:433-43.
Yönal O, Hamzaoğlu HO. What is the most accurate method for the diagnosis of intestinal tuberculosis? Turk J Gastroenterol. 2010;21:91-6.
Zhou ZY, Luo HS. Differential diagnosis between Crohn’s disease and intestinal tuberculosis in China. Int J Clin Pract. 2002;60:212-4.
Tony J, Sunilkumar S, Thomas V. Randomized controlled trial of DOTS versus conventional regime for treatment of ileocecal and colonic tuberculosis. Indian J Gastroenterol. 2008;27:19-21.
Mukewar S, Mukewar S, Ravi R, Prasad A, S Dua K. Colon prospective endoscopic follow-up after anti- tuberculosis treatment. Clin Transl Gastroenterol. 2012;3:e24.