A Rare Clinical Case of Crohn’s disease and Tuberculosis Colitis Presenting with Ileus Obstruction and Pneumothorax: Diagnostic and Therapeutic Challenges
Fhathia Avisha, Vandra Davin, Zikril Ariliusra, Rima Karlina
Universitas Indonesia Hospital
Abstract
Background
Crohn’s disease is an idiopathic inflammatory disease with a definite genetic background and modified by multiple environmental factors. Gastrointestinal TB is a leading extrapulmonary TB manifestation. There are several complications of Gastrointestinal TB and Crohn’s disease such as obstruction, and perforation which may require surgical intervention. Here, we report a case of Crohn’s disease and tuberculosis colitis with clinical presentations of ileus obstruction and pneumothorax.
Case Description
21-year-old female patient with the chief complaints of abdominal pain and shortness of breath, vomiting, and diarrhea. On physical examination we found of abdominal distension, ascites, and decreased of breath sounds. Chest X-ray revealed infiltrates, left pneumothorax, and right pleural effusion. Abdominal X-Ray revealed dilated bowel with obstructive ileus at the level of the small intestine. Abdominal CT scan with contrast showed of small bowel obstruction with diffuse thickening of the intestine and mesentery and calcified lymphadenopathy mesentery and paraaorta, and bilateral pleural effusion. Colonoscopy examination showed the presence of hyperemic mucosa and edema of the colon. Histopathological examination revealed active chronic colitis with distorted crypts and granulomas. The IGRA test was positive. Patient was admitted to the ICU, needle thoracostomy was performed, and decompression with nasogastric tube. Patient received fluid maintenance therapy, transfusion of albumin, antibiotics, anti-tuberculosis drugs, mesalazine, and steroid. On 15th day of hospitalization patient condition’s was worsening and cardiac arrest.
Conclusion
The combination of Crohn’s disease and tuberculosis colitis increased the mortality of patients. Ileus obstruction and pneumothorax are serious complications of this disease. Early diagnosis and holistic management are required. Systemic manifestation, abdominal pain, diarrhea, and ascites can be the symptoms and sign of abdominal tuberculosis and Crohn’s disease. Overlap of symptoms of with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of tuberculosis colitis.
Keywords: Crohn’s disease, Tuberculosis Colitis, Diagnosis, Therapy