Utility of the Single-Balloon Enteroscopy in a Patient with Small Bowel Tuberculosis

Abstract

With the changing epidemiology of Crohn’s disease (CD) and intestinal tuberculosis (ITB), discriminating the two diseases has become increasingly challenging for physicians and delayed diagnosis or misdiagnosis resulted in higher morbidity and mortality. We describe the case of ITB in a 14-year-old boy who presented with chief complaints of lower abdominal pain, high swinging fever, and weight loss over the past 12 months. He had visited different clinics, diagnosed with ileal CD. He received 5-aminosalicylic acid, prednisone, and azathioprine followed by three doses of infliximab, with no response. Abdominal computed tomography revealed terminal ileal stricture with no evidence of an intra-abdominal abscess. Colonoscopy with ileoscopy up to 25 cm from the ileocecal valve showed normal mucosa; retrograde single-balloon enteroscopy was used to delineate multiple transverse ulcers with mild stenosis at 40 cm of the terminal ileum from the ileocecal valve. Pathologic findings revealed mucosal granuloma. The patient was empirically started on four anti-TB medications, and he responded very well within the 1st week of therapy. At the 6-month follow-up, he was still receiving anti-TB treatment, however became asymptomatic, gained weight and on the way to full recovery.