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Archives de pédiatrie
Volume 21, n° 10
pages 1123-1126 (octobre 2014)
Doi : 10.1016/j.arcped.2014.07.008
Received : 20 September 2013 ;  accepted : 21 July 2014
Tuberculose intestinale ou maladie de Crohn : un défi diagnostique
Crohn's disease or intestinal tuberculosis: A diagnostic challenge
 

L. Gargouri a, , M. Boudabous b, F. Safi a, B. Maalej a, H. Mnif c, L. Chtourou b, I. Mejdoub a, L. Mnif b, A. Amouri b, T. Boudawara c, N. Tahri b, A. Mahfoudh a
a Service de pédiatrie, urgences et de réanimation pédiatriques, CHU Hédi Chaker, route El Aïn, Km 0,5, 3029 Sfax, Tunisie 
b Service de gastroentérologie, CHU Hédi Chaker, Sfax, Tunisie 
c Service d’anatomopathologie, CHU Habib Bourguiba, Sfax, Tunisie 

Auteur correspondant.
Résumé

La distinction entre tuberculose intestinale et maladie de Crohn est difficile et peut mener à des erreurs diagnostiques notamment en l’absence d’atteinte pulmonaire active. Nous rapportons le cas d’une fille de 13ans admise pour une diarrhée liquidienne et une douleur abdominale ayant débuté depuis 2 mois, associées à une perte pondérale de 12 kg. Appuyé sur les données cliniques, radiologiques, endoscopiques et anatomopathologiques, le diagnostic de maladie de Crohn avait pu être suspecté et un traitement corticoïde être instauré. Devant l’échec après 4 semaines de traitement et malgré la négativité de la recherche de bacille de Koch, un traitement antituberculeux a été mis en route avec arrêt de la corticothérapie. L’évolution a été rapidement favorable après 7jours de quadrithérapie antituberculeuse. Ce cas illustre les difficultés de diagnostic différentiel entre la tuberculose intestinale et la maladie de Crohn. La réponse aux antituberculeux peut aider à faire la différence entre les 2 entités.

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Summary

Distinguishing intestinal tuberculosis from Crohn disease is difficult and can result in misdiagnosis, especially when active pulmonary infection is absent. A 13-year-old girl was admitted to our hospital with a 2-month history of watery diarrhea, abdominal pain, and 12-kg weight loss. Based on clinical, radiological, endoscopic, and histological findings, she was initially misdiagnosed as having Crohn disease and treated with glucocorticosteroids, with a poor response after 4 weeks. Intestinal tuberculosis was then suspected. Improvement was observed during the 1st week of antituberculous treatment. The differentiation of intestinal tuberculosis from Crohn disease may be very difficult in some patients. A positive response to antituberculous treatment associated with clinical, endoscopic, and histological features argue in favor of the diagnosis of intestinal tuberculosis.

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