酷似肠结核的克罗恩病两例

Crohn’s disease resembling intestinal tuberculosis:a report of two cases

克罗恩病是一种病因不明的肠道慢性肉芽肿性疾病,诊断缺乏金标准,该文报道2例酷似肠结核的克罗恩病的诊治过程,例1因反复腹痛、大便不规律伴体质量下降入院,CT检查提示右肺钙化灶,结核感染T细胞检测(+),内镜检查结果符合肠结核镜下特征,疑为肠结核予抗结核治疗,症状反复,最后经诊断性抗结核治疗及CT小肠成像等资料确诊为内镜表现酷似肠结核的克罗恩病.例2因反复腹痛、大便不规律伴消瘦半年入院,CT提示肺部有结核空洞形成,结核感染T细胞检测(+),内镜活组织病理学检查提示肉芽肿性炎症,高度怀疑肠结核,给予抗结核治疗,症状反复,肺部病变有所好转,最后经手术及大体组织病理学检查等资料确诊为临床表现酷似肠结核的克罗恩病.临床上对于酷似肠结核的克罗恩病难于早诊断早治疗,因此若发现抗结核疗效欠佳时应排除克罗恩病的可能,及时纠正初始诊断并进行相应的治疗.

Crohn’s disease is a chronic granulomatous disease of the intestinal tract with unknown pathogenesis.The diagnosis of Crohn’s disease lacks of gold standard.In this article,we reported the diagnosis and treatment of two cases of Crohn’s disease resembling intestinal tuberculosis.One patient was admitted to our hospital due to chief complaints of abdominal pain,irregular stool and body weight loss.CT scan showed calcified lesions in the right lung.The patient was positive for tuberculosis T cells.Endoscopic examination results were consistent with the microscopic characteristics of intestinal tuberculosis.The patient was suspected with intestinal tuberculosis and received anti-tuberculosis therapy.However,relevant symptoms were untreated and recurrent.Finally,the patient was diagnosed with Crohn’s disease resembling intestinal tuberculosis by diagnostic anti-tuberculosis therapy and CT images of the small intestine.The patient was admitted to our hospital due to recurrent abdominal pain,irregular stool and emaciation for half a year.CT scan prompted the formation of tuberculosis cavity in the lung.The patient was positive for tuberculosis T cell.Endoscopic biopsy showed granulomatous inflammation and high suspicion of intestinal tuberculosis.Anti-tuberculosis treatment was given,whereas relevant symptoms remained recurrent and the lung lesions were mitigated.The patient was eventually diagnosed with Crohn’s disease resembling intestinal tuberculosis by surgery and gross histopathological examination.In clinical practice,it is challenging to deliver early diagnosis and treatment of Crohn’s disease resembling intestinal tuberculosis.Therefore,the possibility of Crohn’s disease should be considered if the clinical efficacy is poor.Besides,the initial diagnosis should be corrected timely and corresponding treatment should be given.