Clinical features of intestinal tuberculosis: an analysis of 46 cases, including six initially misdiagnosed as Crohn's disease.

OBJECTIVE: The purpose of this study was to summarize the clinical, laboratory, endoscopic, imaging, and histopathological features of intestinal tuberculosis (ITB), with a focus on the clinical characteristics of ITB cases initially misdiagnosed as Crohn's disease (CD), to improve clinicians' understanding and diagnosis of ITB. METHODS: The clinical data of patients diagnosed with ITB at the First Affiliated Hospital of Wannan Medical University between 1 January 2012 and 31 December 2025 were retrospectively analyzed. Among them, six patients were initially misdiagnosed as having CD and were analyzed as a separate subgroup. All data were analyzed using descriptive statistical methods. RESULTS: In total, 46 patients with ITB were enrolled in the study. The most common clinical manifestation was abdominal pain (32 cases, 69.56%), followed by abdominal distention (18 cases, 39.13%). The positive rates of the T-Spot assay for tuberculosis (T-SPOT.TB test), purified protein-derived (PPD) test, and chest imaging were 81.25% (26/32), 40.91% (9/22), and 39.13% (18/46), respectively. In the subgroup of six patients with ITB initially misdiagnosed as CD, all six underwent PPD and T-SPOT.TB testing, with positive rates of 50% and 100%, respectively, indicating 50% agreement between the two diagnostic methods. Because ITB could not be ruled out, all six patients received diagnostic antituberculosis therapy and showed a favorable response. CONCLUSION: The clinical manifestations of ITB lack specificity, and its endoscopic and imaging manifestations are diverse, making ITB easily confused with CD. In patients with a high clinical suspicion of ITB, diagnostic antituberculosis treatment can serve as an important auxiliary diagnostic method. Improving the recognition of atypical ITB cases may help reduce misdiagnosis and improve patient prognosis.