Diagnosing Intestinal Tuberculosis and Crohn’s Disease in Children in a tuberculosis endemic Country: A Daunting Challenge

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OBJECTIVE: This study aimed to analyze the clinical, laboratory, endoscopic, and histological features of children with intestinal tuberculosis (ITB) and Crohn's disease (CD). MATERIALS AND METHODS: This single-center retrospective study was done among children with ITB and CD between January 2021 and December 2023. Their baseline demographics, clinical, laboratory, endoscopic, and histological findings were compared. RESULTS: This study included 28 ITB and 21 CD patients. The prevalence of fever (57.1% vs. 14.3%; P=.003), subacute intestinal obstruction (21.4% vs. 0%; P=.031), and positive contact history (25% vs. 0%; P=.015) was more common in ITB patients, whereas nocturnal stooling (33.3% vs. 0%; P=.001), growth failure (66.7% vs. 35.7%; P=.032), extraintestinal manifestation (28.6% vs. 3.6%; P=.033), perianal involvement (33.3% vs. 7.1%; P=.028) predominated in CD patients with longer disease duration (7.3 ± 3.3 months vs. 5.1 ± 4.02 months; P=.003). Higher mean fecal calprotectin level (1145.45 ± 660.45 vs. 566.22 ± 299.18 ug/g; P=.002), left-sided colonic involvement with linear ulcer (42.9% vs. 7.1%; P=.005), aphthous ulcer (38.1% vs. 7.1%; P=.012), skip lesion (28.6% vs. 0%; P=.004), cobble-stoning (19% vs. 0%; P=.028), perianal lesion (33.3% vs. 7.1%; P=.028), and focally enhanced colitis (47.6% vs. 0%; P=.000) were more common in CD patients than ITB patients. CONCLUSION: A combination of clinical features, laboratory tests, and endoscopic evaluation is needed to accurately distinguish CD from ITB in children.

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