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Abstract
Background/Aims
It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohn's disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-γ) assay for differential diagnosis between ITB and CD.
Methods
Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-γ-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis.
Results
Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcet's enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcet's enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively.
Conclusions
When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD.
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Table 1.
Baseline Characteristics of Intestinal Tuberculosis and Crohn's Disease
| Intestinal tuberculosis (n=12) | Crohn's disease (n=44) | p-value | |
|---|---|---|---|
| Male/Female | 6/6 | 31/13 | 0.302 |
| Age, years∗ | 48.5 (29-78) | 24.0 (17-65) | ＜0.001∗ |
| Symtoms or signs | |||
| Abdominal pain | 9 (75.0%) | 39 (88.6%) | 0.348 |
| Fever/≥38 o C | 5/2 (41.7/16.7%) | 0 (0%) | ＜0.001 |
| Weight loss | 5 (41.7%) | 26 (59.1%) | 0.338 |
| Diarrhea | 7 (58.3%) | 35 (79.5%) | 0.151 |
| Intestinal obstruction | 1 (8.3%) | 5 (11.4%) | 0.619 |
| Fistula (enteroenteric/enterovesical) | 0 (0%) | 4/1 (9.1/2.3%) | 0.574 |
| Perianal disease | 0 (0%) | 12 (27.3%) | 0.038 |
| Radiologic findings | |||
| Intestinal wall thickening | 10 (83.3%) | 41 (93.2%) | 0.289 |
| Abdominal lump | 0 (0%) | 3 (6.8%) | 0.478 |
| Mesenteric thickening | 3 (25.0%) | 4 (9.1%) | 0.160 |
| Ascites | 2 (16.7%) | 5 (11.4%) | 0.635 |
| Abdominal | |||
| lymphadenopathy | 7 (58.3%) | 25 (56.8%) | 0.596 |
| Colonoscopic findings | |||
| Ulcerations | 12 (100%) | 42 (95.5%) | 0.614 |
| Transverse/longitudinal/combined | 8/2/2 (66.7/16.7/16.7%) | 8/26/8 (19.0/61.9/19.0%) | |
| Pseudopolyps | 8 (66.7%) | 31 (70.5%) | 0.529 |
| Strictures | 2 (16.7%) | 9 (20.5%) | 0.566 |
| Localization of lesions | |||
| Pancolits | 1 (8.3%) | 13 (29.5%) | 0.127 |
| Ileocecum | 7 (58.3%) | 26 (59.1%) | 0.607 |
| Ascending colon | 3 (25.0%) | 1 (2.3%) | 0.028 |
| Transverse colon | 1 (8.3%) | 0 (0%) | 0.214 |
| Descending colon or sigmoid colon | 0 (0%) | 3 (6.8%) | 0.478 |
| Rectum | 0 (0%) | 1 (2.3%) | 0.786 |
| Histologic findings | |||
| Granuloma | 3 (25.0%) | 5 (11.4%) | 0.348 |
| Caseating | 0 (0%) | 0 (0%) | |
| Non-caseating | 3 (25.0%) | 5 (11.4%) | |
| Ulceration of surface epithelium | 8 (66.7%) | 21 (47.7%) | 0.329 |
| Lymphoid aggregates or follicle | 3 (25.0%) | 16 (36.4%) | 0.732 |
| Chronic inflammation | 5 (41.7%) | 29 (65.9%) | 0.184 |
Table 2.
Results of PCR in Biopsy Specimens and INF-γ in Whole Blood from Patients with Intestinal Tuberculosis and Crohn's Disease
Table 3.
Results of T-SPOT.TB Blood Tests for Differential Diagnosis between Intestinal Tuberculosis and Other Diseases
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