IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 3 Ver.13 March. (2018), PP 16-20 www.iosrjournals.org DOI: 10.9790/0853-1703131620 www.iosrjournals.org 16 | Page Crohn' disease or intestinal tuberculosis, diagnostic dilemma- a case series Sakshi Singhal 1 ,Satish Kumar Bohara 2 , Harshit Agarwal 3 , SC Dutt 4 Department of General Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India Abstract: In a developing country like India, which is endemic for tuberculosis, patients presenting with intestinal obstruction are often misdiagnosed as abdominal tuberculosis. Similarly, Crohn's disease with increasing incidence is being treated with anti tubercular therapy leading to late diagnosis with increased morbidity and mortality. I am hereby presenting a case series of 3 cases who were being mistreated as intestinal tuberculosis and were later diagnosed as Crohn's disease after surgical intervention. Such cases require a deep study, so that undue intervention and anti tubercular therapy can be avoided. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 12-03-2018 Date of acceptance: 28-03-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum, or anus. Less commonly, it can also involve the stomach, esophagus, and mouth. Often the disease will simultaneously affect multiple areas of the gastrointestinal tract. 1 It is unclear how common Crohn's disease might have been prior to 1932, as it is likely that cases of Crohn's disease occurring in an era of limited abdominal surgery may have been mistaken for other processes such as tumor or intestinal tuberculosis. In 1913, Sir Kennedy Dalziel of Glasgow, Scotland, reported in the British Medical Journal on 13 patients and provided what is now recognized as a classical clinical and pathologic description of Crohn's disease. 2 Although not often cited, Dalziel's description predates the one by Crohn, Ginsberg, and Oppenheimer, and some have argued that the disease should be known by the eponym "Dalziel-Crohn's disease." Intestinal tuberculosis (ITB) is caused mainly by Mycobacterium tuberculosis, and to a lesser extent by Mycobacterium bovis , the latter being less common in the western hemisphere due to pasteurization of milk, which is the main vehicle of transmission. Both have a predilection for the small bowel, particularly the terminal ileum, although any part of the gastrointestinal tract may be affected. 3 Both ITB and CD are chronic granulomatous disorders with similarities that make the differentiation between these two entities very difficult but at the same time crucial, as the repercussions of a misdiagnosis carry grave consequence. 4 There have been reports of misdiagnosing ITB as CD for as long as 7 years before the correct diagnosis was reached 5 . In China, Liu et al. has reported that up to 65% of CD had been misdiagnosed as ITB 6 . This case series represents our experience with 3 patients presented with pain in abdomen and sub- acute intestinal obstruction, misdiagnosed as intestinal tuberculosis and ATT was unduly started. Due to no relief in symptoms exploratory laparotomy was done with resection and anastomosis. Post operative biopsy report came out to be suggestive of crohn’s disease. In India, being endemic for tuberculosis it is common to misdiagnose and treat these patients with anti tubercular drugs increasing the morbidity and mortality pertaining to late diagnosis. II. Case Reports Case 1  A 24 years old female presented with complaint of abdominal pain, on & off distension since 2yrs with cough, evening rise of temperature and significant weight loss for 1 year. Patient was admitted in Mahatma Gandhi Hospital multiple times and treated on lines of intestinal tuberculosis as per DOTS regime CAT-I. Took ATT treatment twice past 2 years. Abdominal distension increasing suddenly past 6 months causing respiratory distress. Also c/o passing dark coloured blood per rectally past 20 days.  No h/o malaena or haemetemesis or constipation or obstipation.