title: Abdominal tuberculosis mimicking Crohn's disease's exacerbation: A clinical, diagnostic and surgical dilemma. A case report.
abstract: BACKGROUND
  Tuberculosis in Europe is a health public problem, which has increased constantly over the last few decades. The most common clinical manifestation of tuberculosis is pulmonary. The diagnosis of extrapulmonary tuberculosis can be challenging and clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies.
  
  
  METHODS
  A young Chinese man, who had recently been diagnosed with Crohn's disease, was admitted to the emergency room of our hospital with a one-month history of diffuse abdominal pain and weight loss. The patient initially presented with epigastric pain, which had been constantly increasing over the last 48 h. Other symptoms included diarrhea, nausea, and fever. The patient was then admitted with the diagnosis of Crohn's disease exacerbation, and a treatment with corticosteroids, azathioprine, mesalazine, adalimumab, and antibiotic therapy was started. The symptoms were due to an initially misdiagnosed case of abdominal tuberculosis.
  
  
  CONCLUSIONS
  Intestinal tuberculosis is mainly localized at the ileocecal level in 85% of patients. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage.
  
  
  CONCLUSIONS
  The diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
authors.affiliation: Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: davide.papis@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Papis
authors.affiliation: Department of Surgery, Bonn University Hospital, Sigmund-Freud-Strasse 25, Bonn 53127, Germany. Electronic address: vittorio.branchi@hotmail.com.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Branchi
authors.affiliation: Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: luisgomezquiles@hotmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Gomez
authors.affiliation: Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: ferherias@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Herrerias
authors.affiliation: Anatomical Pathology Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: fvilardell@arnau.scs.es.
authors.forename: Felip
authors.initials: F
authors.lastname: Vilardell
authors.affiliation: Hepatobilyopanctratic Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: jo_marta@hotmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain. Electronic address: jjolsina@gmail.com.
authors.forename: Jorge J
authors.initials: JJ
authors.lastname: Olsina
keywords: Abdominal tuberculosis; Adalimumab; Difficult diagnosis; Medical treatment; Surgery