CLINICAL CASE: Clinical Case-02: Colon ulcers - histology or cytology?

Case Report: A 25-year-old female with no significant medical history was admitted to National University Hospital, Singapore 2 months ago with abdominal pain, vomiting, fever, and melena for 2 weeks. Inflammatory markers were raised with computed tomography (CT) showing diffuse mucosa thickening at terminal ileum, cecum, and ascending colon with multiple lymphadenopathy. Biopsy of the colon showed acute on chronic colitis with granulomas, acid-fast bacilli (AFB) negative (polymerase chain reaction [PCR] and culture). The patient was treated as Crohn’s disease with prednisolone and azathioprine. She came to our hospital 2 months later with fever and loss of appetite. The patient has defaulted treatment for a week as well. Repeat CT and colonoscopy showed similar findings as before. Endoscopic ultrasound (EUS) and fine needle aspiration (FNA) of peripancreatic lymph node were performed. Lymhoid tissue with necrosis and occasional acid fas bacilli were seen. Lymph node culture and PCR for AFB were negative. The patient was treated for tuberculous enteritis and recovered well following completion of therapy. Discussion: Diagnosis of tuberculosis (TB) enteritis can be difficult to establish. The disease may mimic other conditions such as Crohn’s disease and lymphoma. EUS-guided FNA of the lymph nodes has been shown to be helpful in cases where repeated tests for TB were negative.