Misdiagnosis of a Patient with Terminal Ileitis; A Case Report

Pedram Beigvand, Arman Azarpour, Niloofar Moradi, Seyed Hasan Abedi


Abdominal tuberculosis is one of the most critical and life-threatening ailments affecting the digestive system. Distinguishing it from other gastrointestinal disorders is paramount due to the potential complications of treatment overlap. Therapies such as corticosteroids and anti-tumor necrotic factor (anti-TNF) agents, effective against various diseases, can unintentionally exacerbate and propagate tuberculosis.

The case in focus involves a 22-year-old man initially presented with abdominal pain. The clinical, endoscopic, and pathological assessments led to a diagnosis of Crohn's disease. Subsequently, the patient underwent treatment. However, 6 months into the treatment, the patient developed abdominal distension and ascites, necessitating hospital admission and re-evaluation.

A comprehensive series of investigations revealed a diagnosis of military tuberculosis. The patient was subsequently administered four anti-tuberculosis drugs, resulting in a complete resolution of symptoms. This case underscores a crucial point: administering anti-TNF agents can inadvertently contribute to tuberculosis dissemination. Hence, a meticulous assessment to exclude tuberculosis before initiating such treatment is paramount.


Tuberculosis, Crohn's disease, Terminal ileitis, Anti-TNF agents

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