A case report of intestinal tuberculosis diagnosed by double balloon enteroscopy and interferon-γ assay

A 58-year-old woman was admitted in June 2005 with a fever of unknown origin. She had right lower quadrant abdominal pain. CT scan showed a thickened distal ileum wall and mesenteric lymph node enlargement. The differential diagnosis included : Crohn's disease, intestinal tuberculosis, malignant lymphoma, and Yersinia enteritis. On double balloon enteroscopy (DBE), mucosal edema and multiple circular ulcers were found in the distal ileum. On biopsy, a dense infiltration of lymphoid cells and an epithelioid granuloma with Langhans giant cells were noted. The whole-blood interferon-γ assay done using the QuantifFERON ® -TB2 G test (QFT) was positive. Intestinal tuberculosis was diagnosed. The patient's symptoms improved after anti-tuberculous therapy with isoniazid, rifanpicin, pyrazinamide and ethambutol. DBE and QFT were useful for diagnosing small bowel tuberculosis.