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• Tuberculous colitis
  Hans Scherubl
  Published on: 18 April 2016

• Published on: 18 April 2016

  Tuberculous colitis

  • Hans Scherubl, gastroenterologist
  • Other Contributors:
    • Hans Scherubl, Martin Zeitz

  Dear Editor,

  With great interest we read the tutorial by Forbes. We would like to stress that the count of CD4 lymphocytes (and possibly immunoglobulines) might be quite helpful in the differential diagnosis of chronic inflammatory bowel disease and tuberculosis as evidenced by the following case report:

  A 35-year-old Iranian patient presented to our clinic with chronic diarrhea, intermittent abdominal pa...

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  Dear Editor,

  With great interest we read the tutorial by Forbes. We would like to stress that the count of CD4 lymphocytes (and possibly immunoglobulines) might be quite helpful in the differential diagnosis of chronic inflammatory bowel disease and tuberculosis as evidenced by the following case report:

  A 35-year-old Iranian patient presented to our clinic with chronic diarrhea, intermittent abdominal pain and a 10 kg weight loss over the last four months. The right lower abdomen was slightly tender at the physical examination. Routine laboratory tests revealed hypochromic microcytic anemia, an elevated ESR (88 mm in the first hour) and a low serum albumin of 25 g/l (normal range 35-50 g/l). Multiple ulcers with signs of scarring were detected by colonoscopy in the distal ascending colon (Fig. 1a).

  Figure 1a

  

  The histological examination of biopsy specimens disclosed granulomatous disease of the ascending colon (Fig. 1b) but normal mucosa in the more distal colon and the rectum. Despite a normal peripheral leukocyte count, the peripheral CD4 lymphocytes had decreased to 17/µl (normal range 400-1800/µl).

  Figure 1b

  

  HIV infection was excluded. However, the tuberculin test was positive, and Ziehl-Neelsen staining demonstrated acid-fast bacilli in the colonic biopsies (Fig. 1c). The left lung showed some pleural scarring on the chest x-ray. Ultrasound revealed slight pericardial effusion as well as some ascites. Antituberculotic chemotherapy was initiated, and nonresistant Mycobacterium tuberculosis was finally cultured from the colonic biopsies. Now, five years later, the patient is well, and the peripheral CD4 lymphocyte count has normalized.

  Figure 1c

  

  Hans Scherübl, MD
  Charité-Universitätsmedizin Berlin, Germany

  Martin Zeitz, MD
  Campus Benjamin Franklin, Berlin, Germany

  Corresponding address:
  Hans Scherübl, MD,
  Gastroenterologie, Infektiologie, Rheumatologie
  Charité-Universitätsmedizin Berlin,
  Campus Benjamin Franklin
  Hindenburgdamm 30, 12200 Berlin, Germany
  hans.scherubl@charite.de
  Phone: 0049 30 84453534

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  Conflict of Interest:
  None declared.

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