Tuberculosis terminal ileitis: A forgotten entity mimicking Crohn’s disease

Table 1 Criteria of differential diagnosis of intestinal tuberculosis vs Crohn’s disease[1-41]

Parameter	Tuberculosis	Crohn’s disease
Geographic predominance	Asia, India, Pakistan	Western regions, Saudi Arabia
Symptoms
Duration of symptoms	Short (about 7 mo)	Long (about 58 mo)
Abdominal pain	18%-90%	18%-90%
Acute abdomen	67%	Rare
Weight loss	55%-80%	55%-80%
Anorexia	45%	Frequent
Hematochezia	4%-18%	31%
Diarrhea	35%-55%	69% (bloody diarrhea)
Diarrhea alternating with constipation	38%	Rare
Ascites	Frequent	Rare
Anemia	45%-64%	Frequent
Fever	55%-69%	23%-45%
Night sweats	31%	Rare
Intra-abdominal abscesses	Frequent	Frequent (fistula)
Perianal disease	Rare	Frequent (25%-50%)
Extra-intestinal disorders	Pulmonary tuberculosis (60%), neuropathies (vitamin B12 deficiency)	pyoderma gangrenosum, uveitis, primary sclerosing cholangitis, aphthous stomatitis, arthritis, etc.
CT-scan	Thickening of the ileocecal valve and of the medial wall of the cecum and a retracted, conical, and shrunken cecum	Minimal and uniform intestinal wall thickening, mural stratification, vascular jejunization or the comb sign, mesenteric fibrofatty proliferation and skip lesions
Colonoscopy	Transverse and rodent-like ulcers with a patulous ileocecal valve	Longitudinal ulcers and a comb sign
Therapy
Medications	Anti-TB agents (isoniazid, rifampicin, pyrazinamide, streptomycin, ethambutol, etc.)	Steroids anti-tumor-necrosis-factor agents (infliximab)
Surgery	Laparoscopic-assisted ileocolectomies	Usually open surgery

CT: Computed tomography; TB: Tuberculosis.