We
present a case of 36 years old woman investigated in the emergency department
because of intermittent abdominal pain in Right Iliac Fossa (RIF) associated
with distension of the abdomen and nausea. The clinical report reveals a
history of diarrhea, weight loss in the last six months and appendectomy
performed 3 months before. Histological exam of appendix resulted suspicious
for Crohn’s disease (Figure 1-2). In addition the patient reported close
contact with TB affected patient (her mother) in the last year. The blood tests
reveal poorly inflammatory index (CRP 2.11mg/dl) and a mild impairment of liver
tests (AST 53 UI/L, ALT 60UI/L, ALP 279 U/L, ϒ-GT 129 UI/L). Furthermore
serology reveals a positive QuantiFERON-Tb Gold test that confirmed the
positivity of Mantoux reaction. Coproculture and urinoculture were negative for
BK.
Colonoscopy characterized stenosis of
right colon with severe inflammatory response suggestive for Crohn’s Disease
(Figure 3-4). A total-body CT scan performed has shown thickness and oedema of
the last tract of ascending colon that involved part of ileum. In addiction
paracolic and lateral neckcaseous lymphadenitis is described (Figure 5-6). We
perform Fine Needle Aspiration Cytology (FNAC) on lateral neck nodes (Figure 7)
but Ziehl-Neelsen staining methods and RT-PCR resulted negative.
definitive
histopathological examination revealed the presence of granulomatous
inflammation with typical granulomas with localized caseous necrosis properties
of TB (Figure 8-9). The Lowenstein-Jensen culture was positive for KB after 8th week.
The patient underwent anti-TB therapy with resolution of symptoms. The
endoscopic control after 4 months describes normal results of right
hemicolectomy without any sign of inflammation.
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