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<p>Abdominal tuberculosis is a rare form of tuberculosis often mistaken for conditions like inflammatory bowel disease or malignancy due to overlapping symptoms such as abdominal pain, fever, weight loss, and gastrointestinal bleeding. We present a patient with a presumed diagnosis of Crohn’s disease who continued to have abdominal pain, fever, and diarrhea despite infliximab therapy. Imaging revealed new-onset ascites with peritoneal nodularity, and repeated QuantiFERON-TB Gold Plus tests were negative. Paracentesis showed elevated adenosine deaminase, and omental biopsy confirmed tuberculosis, despite non-necrotizing granulomas and negative acid-fast bacilli smears. He had complete resolution of symptoms after nine months of rifampin, isoniazid, pyrazinamide, and ethambutol. Repeat imaging and colonoscopy showed no residual disease, refuting the initial diagnosis of Crohn’s disease. Our case highlights the importance of considering abdominal tuberculosis in patients from high-risk backgrounds with presumed Crohn’s disease worsening on biologic therapy, regardless of having multiple negative QuantiFERON tests.</p>

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A diagnostic dilemma: abdominal tuberculosis mimicking suspected Crohn’s disease or latent tuberculosis activated by biologic therapy

  • 期刊论文

  • 发表日期：

    2026年4月19日

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  • Anthony Papale,
  • Robert Flattau,
  • Michael Delicce,
  • Fernanda Mitchell,
  • Ronald Greenberg,
  • Keith Sultan

摘要

Abdominal tuberculosis is a rare form of tuberculosis often mistaken for conditions like inflammatory bowel disease or malignancy due to overlapping symptoms such as abdominal pain, fever, weight loss, and gastrointestinal bleeding. We present a patient with a presumed diagnosis of Crohn’s disease who continued to have abdominal pain, fever, and diarrhea despite infliximab therapy. Imaging revealed new-onset ascites with peritoneal nodularity, and repeated QuantiFERON-TB Gold Plus tests were negative. Paracentesis showed elevated adenosine deaminase, and omental biopsy confirmed tuberculosis, despite non-necrotizing granulomas and negative acid-fast bacilli smears. He had complete resolution of symptoms after nine months of rifampin, isoniazid, pyrazinamide, and ethambutol. Repeat imaging and colonoscopy showed no residual disease, refuting the initial diagnosis of Crohn’s disease. Our case highlights the importance of considering abdominal tuberculosis in patients from high-risk backgrounds with presumed Crohn’s disease worsening on biologic therapy, regardless of having multiple negative QuantiFERON tests.