Can an immunohistochemistry method differentiate intestinal tuberculosis from Crohn's disease in biopsy specimens?
BACKGROUND
It is sometimes difficult to diagnose whether a patient has intestinal tuberculosis or Crohn's disease because both have similar clinical, pathologic, and endoscopic features. However, their therapies are completely different and a mistake in diagnosis can result with deterioration. Many laboratory methods for the diagnosis of tuberculosis require considerable time to receive a diagnostic result. We wanted to evaluate whether an immunohistochemical tuberculosis staining method can be helpful for faster differentiation of biopsy materials.


METHODS
We used formalin-fixed paraffin-embedded histologically diagnosed small intestine (n=1), colon (n=7), skin (n=8), lung (n=5), lymph node (n=24) tuberculosis and Crohn's disease (n = 28) biopsy materials only with granulomas. Demographic characteristics like age and gender were also obtained. Pathology specimens were stained immunohistochemically with an antibody to VP-M660, targeting the 38-kDa antigen of Mycobacterium tuberculosis.


RESULTS
In the M. tuberculosis group, 33/45 of patients have positive immunohistochemistry (IHC) staining (73% sensitivity, 93% specificity), whereas only two of 28 patients have positive staining in the Crohn's group (p<0.001). The positive staining with IHC was detected as 85.7, 75, 75, and 60% in colon, lymph node, skin, and lung granulomas, respectively, in M. tuberculosis patients.


CONCLUSIONS
Immunohistochemical staining of biopsy specimens with anti-VP-M660 seems to be a simple and fast technique with 73% sensitivity and 93% specificity for establishing an earlier differentiation of M. tuberculosis from Crohn's disease.
Ince
Ali Tüzün
AT
Gastroenterology Clinic, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey. alince@superonline.com
Güneş
Pembegül
P
Senateş
Ebubekir
E
Sezikli
Mesut
M
Tiftikçi
Arzu
A
Ovünç
Oya
O
D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D001706:Biopsy; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D055815:Young Adult
D000942:Antigens, Bacterial; C072681:Mycobacterium tuberculosis antigens
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