title: Intestinal tuberculosis masquerading as difficult to treat Crohn disease: a case report.
abstract: BACKGROUND
  Crohn disease has low prevalence in Sri Lanka while compared to the West, while intestinal tuberculosis is common in the region. Since clinical, endoscopic and investigation features of Crohn disease overlap with intestinal tuberculosis, differentiating these two conditions becomes a dilemma for the clinician in the intestinal tuberculosis endemic setting. An 18-year old Sri Lankan Muslim female presented with chronic abdominal pain and weight loss. Colonoscopy revealed an ulcerated ileocaecal valve and a terminal ileal stricture. Biopsy confirmed Crohn disease with no supportive features to suggest intestinal tuberculosis. Despite treatment with adequate immunosuppression she failed to improve and underwent a limited right hemicolectomy and terminal ileal resection. Histology confirmed intestinal tuberculosis and she made full recover with 6 months of anti-tuberculosis treatment.
  
  
  CONCLUSIONS
  This case illustrates the importance of reviewing the diagnosis to include intestinal tuberculosis in an endemic setting, when already diagnosed Crohn disease is treatment refractory.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, P O Box 6, Thalagolla Road, Ragama, GQ 11010, Sri Lanka. maduniln@yahoo.co.uk.
authors.forename: Madunil A
authors.initials: MA
authors.lastname: Niriella
authors.affiliation: University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
authors.forename: S Kuleesha
authors.initials: SK
authors.lastname: Kodisinghe
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, P O Box 6, Thalagolla Road, Ragama, GQ 11010, Sri Lanka.
authors.forename: Arjuna P
authors.initials: AP
authors.lastname: De Silva
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, P O Box 6, Thalagolla Road, Ragama, GQ 11010, Sri Lanka.
authors.forename: Janaki
authors.initials: J
authors.lastname: Hewavisenthi
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, P O Box 6, Thalagolla Road, Ragama, GQ 11010, Sri Lanka.
authors.forename: Hithanadura J
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000293:Adolescent; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: Crohn disease; Intestinal; Tuberculosis