Crohn's Disease in which Differential Diagnosis with Intestinal Tuberculosis was Difficult, Report of a Case Seiji Shimizu 1 , Kunihiko Kimoto 1 , Nobuyuki Sugeta 2 , Yusuke Okuyama 2 1Department of Gastroenterology, Osaka Railway Hospital 2Department of Gastroenterology, Kyoto First Red Cross Hospital Keyword: Crohn病 , 腸結核 , 診断基準 , 敷石像 pp.195-200
Published Date 2001/2/25
DOI https://doi.org/10.11477/mf.1403103112
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 A case report of Crohn's disease in which differential diagnosis with tuberculosis was difficult. A 31-year-old male was admitted to our hospital complaining of diarrhea, abdominal pain, and body weight loss. Colonoscopy revealed multiple ulcers around the ileocecal valve, ulceration of the ileocecal valve with stenosis, and narrowing of the cecum. Histological examination of the biopsy specimens could not demonstrate granulomas. Barium enema x-ray disclosed a segment of stenosis with irregular contour and a skipped ulceration on the proximal side. Bacteriological studies were negative, and PPD skin test was also negative. Symptoms continued despite parenteral nutrition for two weeks and steroid therapy was started. Thereafter, symptomatic amelioration was observed in a short period. According to the diagnostic criteria of Crohn's disease, the demonstration of longitudinal ulcers, cobblestone appearance, or epithelioid granulomas are essential for diagnosis of Crohn's disease, but such findings were not demonstrated in this reported case. Improvement of the diagnostic criteria to include such atypical cases is desired.

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