Henen Sara, Denton Christine, Miller Aaron, Pappa Helen
From the Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO.
Department of Pediatrics, Saint Louis University, St. Louis, MO.
JPGN Rep. 2021 Jul 12;2(3):e103. doi: 10.1097/PG9.0000000000000103. eCollection 2021 Aug.
Differentiating abdominal tuberculosis (TB) from Crohn's disease (CD) despite the rarity of the condition remains vital to avoid catastrophic consequences of disseminated miliary TB as a result of mistakenly starting an immunosuppressive medication. We highlight a challenging pediatric abdominal TB case of a 5-year-old male that presented with failure to thrive, ascites, and diarrhea. Our case aims to shed light on a forgotten disease in our developed world by highlighting subtle clinical, endoscopic, and histologic features. Findings of caseating necrosis on biopsy, positive smear for acid-fast bacillus (AFB), AFB culture, and necrotic lymph node on imaging are diagnostic of TB but are rarely present. Clinicians should be vigilant in screening pediatric patients with elusive symptoms, history, and exam. TB should be suspected, and one should not shy away from empirical antituberculous treatment as it could be the only way of establishing the diagnosis.
尽管腹部结核（TB）罕见，但将其与克罗恩病（CD）区分开来对于避免因错误地开始使用免疫抑制药物而导致播散性粟粒性结核的灾难性后果仍然至关重要。我们重点介绍了一例具有挑战性的儿科腹部结核病例，一名5岁男性患儿，表现为发育不良、腹水和腹泻。我们的病例旨在通过强调细微的临床、内镜和组织学特征，来揭示我们发达国家中一种被遗忘的疾病。活检发现干酪样坏死、抗酸杆菌（AFB）涂片阳性、AFB培养阳性以及影像学上的坏死淋巴结可诊断为结核，但这些表现很少出现。临床医生在筛查有难以捉摸的症状、病史和检查结果的儿科患者时应保持警惕。应怀疑结核，且不应回避经验性抗结核治疗，因为这可能是确立诊断的唯一方法。
